 |  | Rudolph's Pediatrics Section 21. Disorders of the Gastrointestinal System > Part 2. Esophageal Disorders > Chapter 394. Gastroesophageal Reflux and Other Causes of Esophageal InflammationColin D. Rudolph | |
Topics Discussed: asthma; esophagitis; gastroenterology and hepatology; gastroesophageal reflux disease; pharmacotherapy; pneumonia, recurrent.
Sections: Inflammatory Disorders of the Esophagus Other Than GERD, References.
Excerpt:"Gastroesophageal reflux (GER) is the spontaneous passage of gastric
contents into the esophagus. It is a normal physiologic process that
occurs throughout the day in healthy infants, children, and adults.
In infants, refluxed material often is expelled from the mouth,
a benign process known as "spitting-up," "spilling," or "posseting." Gastroesophageal
reflux disease (GERD) results from failure of the normal protective
mechanisms that prevent damage to the aerodigestive tract following
GER and is purported to manifest with a variety of symptoms and
signs, shown in Figure 394-1. For almost all
of these symptoms and signs, alternative etiologies must be considered
prior to concluding that GERD is causative. This is particularly
true in the infant and younger child because it is difficult to differentiate
in young patients between GER and vomiting, and their symptoms are
nonspecific.Half of all infants between 0 and 3 months of age and two thirds
of 4- to 6-month-old infants regurgitate at least once per day.
The prevalence of regurgitation decreases dramatically after 8 months
of age1,2 (eFig. 394.1).
Typically, these infants are otherwise thriving and outgrow this problem
by 18 to 24 months of age. Infants with GER are not at increased
risk of ear, sinus, upper respiratory infections, or wheezing compared
to a control population, but there may be a higher likelihood of
feeding refusal than was found among the control infants.1 Gender,
breast-feeding, and..."
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