A 4-month-old presents with frequent post-prandial regurgitation. The symptoms have been present since birth but have worsened when the mother increased the formula feeding volumes... A 4-month-old presents with frequent post-prandial regurgitation. The symptoms have been present since birth but have worsened when the mother increased the formula feeding volumes. The patient's weight is less than it was at the three-month check-up. General examination is otherwise normal. Blood pressure 80/40 mmHg, Heart rate 120/min, Respiratory rate 32/min, Temperature 36.6° C. Which of the following is the most likely cause? A. Duplication of the gastric pylorus B. Erosion of the lower esophagus C. Infection of the gastric antrum D. Decreased Lower Esophageal Sphincter pressure
Understand the Problem
This is a clinical case question. We need to determine the most likely cause of frequent post-prandial regurgitation in a 4-month-old infant, considering the provided symptoms and examination findings. The key factors are the onset since birth, worsening with increased feeding volume, weight loss, and normal general examination.
Answer
Decreased Lower Esophageal Sphincter pressure
The most likely cause is Decreased Lower Esophageal Sphincter pressure, as the symptoms described are indicative of gastroesophageal reflux (GERD), which is common in infants due to the immaturity of the LES.
Answer for screen readers
The most likely cause is Decreased Lower Esophageal Sphincter pressure, as the symptoms described are indicative of gastroesophageal reflux (GERD), which is common in infants due to the immaturity of the LES.
More Information
The Lower Esophageal Sphincter (LES) is a muscular ring that closes off the esophagus from the stomach. When it doesn't close properly, stomach contents can leak back into the esophagus, causing reflux. Regurgitation and spitting up are common in infants, but if it leads to poor weight gain it can be clinically relevant.
Tips
It's easy to confuse GER (Gastroesophageal Reflux) and GERD (Gastroesophageal Reflux Disease). GER is normal and a common occurrence in babies. GERD is when the reflux causes problems.
Sources
- Diagnosis and Treatment of Gastroesophageal Reflux in Infants and ... - aafp.org
- Pediatric Gastroesophageal Reflux Clinical Practice Guidelines - pmc.ncbi.nlm.nih.gov
- Spitting up in babies: What's OK, what's not - Mayo Clinic - mayoclinic.org
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