Gastroesophageal Reflux in Children

Physiologic GER usually resolves by 12–15 mo of age.

10% of pyloric stenosis pts.

After diaphragmatic hernia, tracheoesophageal fistula, and esophageal atresia repairs

Neurologically impaired, developmentally delayed, trisomy syndromes, and hiatal hernia.

Aspiration during induction of anesthesia

Severe bronchospasm in pts with RAD

Decreased pulm reserve secondary to chronic aspiration and pneumonitis

Pulm complications from aspiration pneumonitis and RAD

Anemia and malnutrition

Lower esophageal sphincter function matures by 6 wk postnatal age.

GER is defined as regurgitation without pathologic consequences. GERD is defined as regurgitation resulting in esophagitis, nutritional compromise, and/or respiratory complications.

Presence of a hiatal hernia does not necessarily mean pt will have GER.

Sandifer syndrome: Opisthotonos or other abnormal head movements.

Older children may complain of heartburn, dysphagia, and chest and abdominal pain.

Degree of reflux, duration of acid exposure in the esophagus, and ability of the esophagus to clear the reflux material help determine extent of mucosal damage and degree of esophagitis.

Esophagitis may lead to bleeding, which may result in hematemesis, iron-deficiency anemia, and esophageal stricture. Also, pts are predisposed to Barrett esophagus.

GER may be a cause of neonatal apnea.

Diagnostic procedures include upper GI series, esophagoscopy, and esophageal pH probe.