Gastroesophageal Reflux

• ● Regurgitation of stomach secretions into the esophagus through the gastroesophageal or cardiac valve.

  ● Occurs mainly in infants and adolescents.

  ● Caused by relaxed cardiac sphincter or overdistention of stomach by gas or overfeeding.
• ● Vomiting appears effortless and is not projectile.

  ● Irritable child with periods of apnea.

  ● Acidic gastric secretions of pH < 7.0 into esophagus.

  ● In adolescents, heartburn 30 to 60 minutes after meals.

  ● Esophageal manometry shows less strength of esophageal sphincter.

  ● Fiberoptic endoscopy or esophagography with barium swallow shows involved sphincter and reflux of stomach contents into the esophagus are present. This condition may also be associated with the development of esophageal cancer later in life
• MANAGEMENT

  1. Feed infants formula thickened with rice cereal, 1 tbsp of cereal per 1 oz of formula or breast milk.

  2. Position head upright, elevated 30º to 45º during and 1 hour after feeding.

  3. Give small, frequent feedings with adequate burping.
• 4. Give H2 receptor antagonist such as RANITIDINE (Zantac) or proton pump inhibitor such as OMEPRAZOLE (Prilosec) to reduce possibility of stomach acid contents irritating the esophagus.

  5. If problem does not disappear as child grows, botulinum toxin may be injected into lower esophageal sphincter to temporarily relieve symptoms of obstruction.
• 6. If medical therapy is ineffective, a laparoscopic or surgical myotomy procedure to narrow the esophageal sphincter must be done

  ● To correct the GERD

  All these interventions prevent the reflux of gastric contents and ensure normal passage of foods and fluid down the alimentary canal.