Gastroesophageal Reflux Disease (GERD) Concepts

Study Notes

Refers to the regurgitation of stomach secretions into the esophagus through the lower esophageal sphincter
Transient lower esophageal sphincter relaxations develop reflux disease
Dysfunctional lower esophageal sphincter loosens independent of swallowing and has a decreased ability to constrict, allowing stomach contents to regurgitate back into the esophagus due to sphincter insufficiency

Occurs due to the immaturity of the lower esophageal sphincter, allowing easy regurgitation of gastric contents into the esophagus
Typically starts within 1 week after birth and may be associated with a hiatal hernia
Complications of GERD in infants include:
- Irritability
- Failure to thrive
- Esophagitis
- Aspiration pneumonia
- Wheezing
- Apnea

Upper GI series: to look for anatomical abnormalities such as intestinal malrotation
pH probe: to calculate the amount of acidic reflux into the esophagus in a 24-hour period
Esophageal manometry: to assess esophageal motility and ensure normal esophageal peristalsis
Endoscopy: to obtain biopsies and assess the degree of esophagitis

Feed infants a formula thickened with rice cereal
Hold infants in an upright position and keep them upright for at least 30 minutes post-feeding
Avoid placing infants in car seats at home
Avoid tight clothing and diapers
Avoid exposure to cigarette smoke
Breastfeeding mothers may need to eliminate dairy from their diet or try a hypoallergenic formula for 2 weeks
Ranitidine (Zantac) or omeprazole (Prilosec) may be prescribed

Laparoscopic or surgical fundoplication: wrapping the upper portion of the stomach (fundus) around the lower esophagus to prevent regurgitation of stomach contents
Nasogastric tube in place after surgery to assess drainage, color, and patency

Young children may present with vomiting
Older children and adolescents may have similar symptoms to adults
Chronic reflux can lead to erosion of the esophagus with perforation or stricture
Certain conditions, such as cerebral palsy, Down syndrome, cystic fibrosis, and obesity, can increase the risk of GERD

A condition in infants that blocks food from entering the small intestine
Hypertrophy or hyperplasia of the muscle surrounding the sphincter occurs, making it difficult for the stomach to empty
Normally, a muscular valve (pylorus) between the stomach and small intestine holds food in the stomach until it is ready for the next stage in the digestive process
In pyloric stenosis, the pylorus muscles thicken and become abnormally large, blocking food from reaching the small intestine
Incidence: 1:150 in males and 1:750 in females, most frequently in first-born White male infants