{
 "topic": "Gastroesophageal Reflux Disease",
 "slug": "gastroesophageal-reflux-disease",
 "category_id": 15778,
 "passage_count": 14,
 "source_chars": 12479,
 "enough_material": true,
 "references": [
  {
   "title": "Pediatrics for Practitioner (Sharad Thora)",
   "author": null,
   "pages": [
    412
   ]
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    2275
   ]
  },
  {
   "title": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition",
   "author": "Hay, William W., Levin, Myron J., Deterding, Robin R., Abzug, Mark J.",
   "pages": [
    659
   ]
  },
  {
   "title": "Algorithms in Pediatrics",
   "author": null,
   "pages": [
    339
   ]
  },
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    7760
   ]
  },
  {
   "title": "Netters Pediatrics (Florin \u0422., Ludwig St.)",
   "author": null,
   "pages": [
    701
   ]
  },
  {
   "title": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan)",
   "author": null,
   "pages": [
    118,
    161
   ]
  },
  {
   "title": "Pediatric Otolaryngology (American Academy of Pediatrics) ( etc.)",
   "author": null,
   "pages": [
    157
   ]
  }
 ],
 "passages": [
  {
   "source": "Pediatrics for Practitioner (Sharad Thora), p. 412",
   "text": "## **Recognition and Management of Gastroesophageal Reflux Disease** 55 _Rakesh Mishra_ ## **Definitions** _Gastroesophageal reflux (GER)_ : Physiologic passage of gastric contents into the esophagus. _Gastroesophageal reflux disease (GERD)_ : Outcome of excessive reflux; symptoms or complications of GER affecting the esophagus, oropharynx or respiratory tract. ## **Natural History** - Gastroesophageal reflux is a physiologic process that occurs in healthy infants and children - GERD is the most common esophageal disorder in children of all ages. GERD commonly manifests as recurrent vomiting. The prevalence of recurrent vomiting in newborns is approximately 50% which increases to 67% at 3\u20134 months of life - Spontaneous remission of symptoms of regurgitation occurs in over 80% of children by 18 months of age - In general pediatric population (1\u201312 years of age) prevalence of GERD is 5\u20137%"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 2275",
   "text": "Gastroesophageal reflux disease (GERD) is the most common esophageal disorder in children of all ages. Gastroesophageal reflux (GER) signifies the retrograde movement of gastric contents across the lower esophageal sphincter (LES) into the esophagus, which occurs physiologically every day in all infants, older children, and adults. Physiologic GER is exemplified by the effortless regurgitation of normal infants and runs an uncomplicated course. Natural history studies observe that it is uncommon for physiologic GER to have onset before 1 week and to persist beyond 6 months of age, and usually peaks between 3 and 4 months. The phenomenon becomes **pathologic GERD** in infants and children who manifest or report bothersome symptoms because of frequent or persistent GER, producing esophagitis- related symptoms, or extraesophageal presentations, such as respiratory (cough, wheezing, hoarse voice) symptoms, nutritional effects, or growth failure. However, the clinical differentiation between GER and GERD is not"
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 659",
   "text": "## ESSENTIALS OF DIAGNOSIS & TYPICAL FEATURES - \u00bb Key definitions: - \u00bb **Gastroesophageal reflux (GER)** refers to uncomplicated recurrent spitting and vomiting in healthy infants that resolves spontaneously. - \u00bb **Gastroesophageal reflux disease (GERD)** is present when reflux causes secondary symptoms or complications. - \u00bb **Esophageal manifestations of GERD** include symptoms (heartburn, regurgitation) and mucosal complications (esophagitis, stricture, Barrett esophagus) primarily related to acid exposure in the upper gastrointestinal (GI) tract, primarily the esophagus itself. - \u00bb **Extraesophageal manifestations of GERD** include a myriad of clinical disorders that may be linked to reflux, including upper and lower airway symptoms and findings, as well as dental erosions. In most settings, objective confirmation of extraesophageal reflux complications is challenging. common infant symptom. Infant GER is usually benign, and it is expected to resolve by 12\u201318 months of life."
  },
  {
   "source": "Algorithms in Pediatrics, p. 339",
   "text": "Gastroesophageal reflux disease (GERD) has been evaluated as a cause of wheezing in children but still many questions remain unanswered. Gastroesophageal reflux disease is physiological and whether the \u201cD: the disease\u201d can be attributed to reflux or is just a cotraveler, needs to be defined for each case. Children with severe episodes, especially less than 6 months are more likely to have GERD as the sole or one of the reasons of persistent or recurrent wheezing. Investigations are required only in children suspected to have atypical causes of wheezing. The red flag signs in Box 1 should prompt referral for a detailed evaluation. Focused investigations would be required and might include GER scan/24 h pH study, flexible bronchoscopy, sweat chloride test, and computed tomography chest. ## **TREaTMENT** ## **acute Episode**"
  },
  {
   "source": "Cover, p. 7760",
   "text": "## **Complications** _**GASTROESOPHAGEAL REFLUX DISEASE**_ A high incidence of gastroesophageal reflux disease (GERD) is reported in infants and children with CF and may exacerbate lung disease through aspiration and reflex bronchospasm. GERD in infants initially can be treated conservatively by nonpharmacologic strategies including reducing feed volumes, thickening of feeds, and positioning after feeds for infants and young children. Dietary modifications including avoidance of foods that exacerbate symptoms and small frequent meals are recommended for older children. Medical treatment includes use of gastric acid secretion blockers (eg, proton pump inhibitors) and prokinetic drugs (if associated with gastroparesis). Surgical treatment with fundoplication is rarely indicated and reserved for medically refractory cases of GERD. Alternative causes of recurrent vomiting need to be considered prior to surgery."
  },
  {
   "source": "Netters Pediatrics (Florin \u0422., Ludwig St.), p. 701",
   "text": "## **GASTROESOPHAGEAL REFLUX** Gastroesophageal reflux (GER) is the intermittent movement of gastric contents into the esophagus. Infrequent GER is a normal process in all age groups. However, GER becomes pathologic when it causes clinical symptoms and is then labeled gastroesophageal reflux disease (GERD). GERD is the most common esophageal disorder in children of all ages. Emesis from GER occurs in 67% of all 4-month-old infants, and heartburn and epigastric pain from GERD occur in 1% to 8% of children. The incidence of GERD is increased in the population of children born prematurely and in those children with neurologic, pulmonary, and developmental disorders. ## **ETIOLOGY AND PATHOGENESIS**"
  },
  {
   "source": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan), p. 161",
   "text": "18. Ruig\u00f3mez A, Wallander MA, Lundborg P, Johansson S, Rodriguez LA. Gastroesophageal reflux disease in children and adolescents in primary care. Scand J Gastroenterol. 2010;45:139\u201346. 19. Martigne L, Delaage PH, Thomas-Delecourt F, Bonnelye G, Barth\u00e9l\u00e9my P, Gottrand F. Prevalence and management of gastroesophageal reflux disease in children and adolescents: a nationwide cross-sectional observational study. Eur J Pediatr. 2012;171:1767\u201373. 20. Rey E, Moreno-Elola-Olaso C, Rodriguez-Artalejo F, Diaz-Rubio M. Medical consultation for gastro-oesophageal reflux symptoms: reasons and associated factors. Digestion. 2004;70:173\u20137. Y. Vandenplas and S. Kindt 148 21. Flameling RD, Numans ME, ter Linde J, de Wit NJ, Siersema PD. Different characteristics of patients with gastro-oesophageal reflux disease on their path through healthcare: a population follow-up study. Eur J Gastroenterol Hepatol. 2010;22:578\u201382. https://doi.org/10.1097/MEG.0b013e328335638c."
  },
  {
   "source": "Pediatric Otolaryngology (American Academy of Pediatrics) ( etc.), p. 157",
   "text": "**132** **Chapter 6: Rhinosinusitis** Gastroesophageal reflux (GER) has been implicated in many aerodigestive disorders, including RS. Children with a history of chronic cough, hoarseness, and asthma are especially suspect for having GER. Nasopharyngeal reflux has been documented in children with symptoms of CRS and associated with coughing paroxysms. Gastro esophageal reflux may directly injure mucosa, thereby initiating an inflammatory response that leads to sinonasal edema and impaired mucociliary clearance. Evaluation for GER should be considered in patients with a history of reflux as an infant, poor weight gain, and reactive airway disease. **Pearl: Evaluation for gastroesophageal reflux should be considered in patients with a history of reflux as an infant, poor weight gain, recurrent or chronic rhinosinusitis, and reactive airway disease.**"
  },
  {
   "source": "Pediatric Board Study Guide, p. 760",
   "text": "Adapted from Nelson et al. [2], with permission _GERD_ Gastroesophageal reflux disease R. D. Baker 758 - Older infant and child - Gastroenteritis - Infections - Intussusception - Anaphylaxis - Adrenal crisis - Increased intracranial pressure - Cyclic vomiting - Migraine - Eosinophilic esophagitis or gastroenteritis - Child abuse - Adolescent - Functional dyspepsia - Functional nausea and vomiting - Appendicitis - IBD - Pregnancy - Bulimia, psychogenic vomiting - Rumination syndrome ![](/tmp/pdf-images/pdf-0760-21.png) **Fig. 22.4** Barium swallow image showing severe reflux - Cannabinoid hyperemesis syndrome ## **Further workup (Fig 22.4)** - Upper GI radiograph to look for partial obstruction ## **Esophagus** ## **Gastroesophageal Reflux in an Infant** - pH probe/impedance off medication to quantify reflux, on medication to assess the efficacy of acid suppression"
  },
  {
   "source": "Update in Pediatrics, p. 361",
   "text": "**15** Teresa Y. Oh, Tatyana Hofmekler, and A. Jay Freeman ## **Reflux** Gastroesophageal reflux (GER), the physiological passage of gastric contents into the esophagus, occurs in over two-thirds of otherwise healthy infants with daily \u201cspitting-up\u201d and represents a common topic of parenteral concern at well child visits within the first year (Lightdale and Gremse 2013). Gastroesophageal reflux disease (GERD), is reflux associated with troublesome symptoms and is estimated to occur in 10\u201320% of infants and 5\u20138% of children in North America (Nelson et al. 2000; Dent et al. 2005). Peak incidence of GERD occurs for most infants around 4 months of age with only 5\u201310% of patients continuing to experience symptoms at 12 months (Martin et al. 2002). GERD can present in a variety of manners depending on age (see"
  },
  {
   "source": "Textbook of Pediatric Gastroenterology, Hepatology and Nutrition (Stefano Guandalini, Anil Dhawan), p. 118",
   "text": "## **Clinical Features** The clinical approach to evaluate a suspected infectious esophagitis is guided by the presence of any underlying immunosuppression, the presenting symptoms, and the physical findings. Pathologic gastroesophageal reflux is the most common cause of esophagitis in children. In previously healthy children, esophageal symptoms are likely to be caused by reflux esophagitis, whereas in immunocompromised patients, the physician needs to rule out infectious esophagitis. Secondary bacterial or fungal infections can be present in reflux esophagitis and Chagas disease, especially with severe inflammation and obstruction. Absence of reflux symptoms (long-standing heartburn, a water brash taste in the mouth, vomiting, spitting up in infants, pillow wetting, or coughing) does exclude reflux esophagitis. Achalasia, diffuse esophageal spasm, foreign body impaction, and mediastinal or retropharyngeal abscesses can cause esophageal symptoms and may result in secondary infection [2]."
  },
  {
   "source": "CURRENT Diagnosis and Treatment Pediatrics, Twenty-Fourth Edition, p. 659",
   "text": "## **B. Older Children With Reflux** Older children with GERD complain of adult-type symptoms such as regurgitation into the mouth, heartburn, and dysphagia. Esophagitis can occur as a complication of GERD and requires endoscopy with biopsy for diagnostic confirmation. Children with asthma, cystic fibrosis, developmental handicaps, hiatal hernia (HH), and repaired tracheoesophageal fistula are at increased risk of GERD and esophagitis. ## **C. Extraesophageal Manifestations of Reflux Disease** ## \u00bb **Clinical Findings** ## **A. Infants With Gastroesophageal Reflux** Gastroesophageal (GE) reflux is common in young infants and is a physiological event. Frequent postprandial regurgitation, ranging from effortless to forceful, is the most"
  },
  {
   "source": "Illustrated Textbook of Paediatrics (Tom Lissauer, Will Carroll), p. 248",
   "text": "Gastro-oesophageal reflux is the involuntary passage of gastric contents into the oesophagus. It is extremely common in infancy. It is caused by inappropriate relaxation of the lower oesophageal sphincter as a result of functional immaturity. A predominantly fluid diet, a mainly horizontal posture and a short intraabdominal length of oesophagus all contribute. While common in the 1st year of life, nearly all symptomatic reflux resolves spontaneously by 12 months of age. This is probably due to a combination of maturation of the lower oesophageal sphincter, assumption of an upright posture and more solids in the diet. Most infants with gastro-oesophageal reflux have recurrent regurgitation or vomiting but are putting on weight normally and are otherwise well, although the mess, smell, and frequent changes of clothes (5% of those affected have 6 or more episodes each day) is frustrating for parents and carers."
  },
  {
   "source": "Berkowitz's Pediatrics, p. 935",
   "text": "**910 PART 11: GASTROINTESTINAL DISORDERS** ## **Selected References** Martigne L, Delaage PH, Thomas-Delecourt F, Bonnelye G, Barth\u00e9l\u00e9my P, Gottrand F. Prevalence and management of gastroesophageal reflux in children and adolescents: a nationwide cross-sectional observational study. _Eur J Pediatr_ . 2012;171(12):1767\u20131773 PMID: 22903328 https://doi.org/10.1007/ s00431-012-1807-4 Michail S. Gastroesophageal reflux. _Pediatr Rev_ . 2007;28(3):101\u2013110 PMID: 17332169 https://doi.org/10.1542/pir.28-3-101 Rosen R. Gastroesophageal reflux in infants: more than just a pHenomenon. _JAMA Pediatr_ . 2014;168(1):83\u201389 PMID: 24276411 https://doi.org/10.1001/ jamapediatrics.2013.2911 Rudolph CD, Hassall E. Gastroesophageal reflux. In: Walker WA, Kleinman RE, Goulet OJ, et al, eds. _Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis and Management_ . 6th ed. Beijing, China: People\u2019s Medical Publishing House; 2018:77\u201397"
  }
 ]
}