What Are the Symptoms of GERD in an Infant?

Gastroesophageal reflux (GER) refers to the reflux of stomach and / or duodenal contents into the esophagus. GER is very common in children. It is divided into two types: physiological and pathological. The vast majority are physiological and the reflux is not heavy. With the increase of age, the reflux gradually decreases, and it naturally relieves to about 1 year old. Causes adverse effects, more common in newborns and small infants after feeding temporary reflux and functional reflux (or vomiting), which does not cause pathological damage. If the reflux is severe or persistent, or combined with aspiration pneumonia, asphyxia, and affecting normal growth and development, it is pathological, also known as gastroesophageal reflux disease (GERD).

Basic Information

Visiting department

Pediatrics

Common locations

esophagus

Common causes

Reflux of stomach and / or duodenal contents to the esophagus

Common symptoms

Vomiting, acid reflux, heartburn

Causes of gastroesophageal reflux in infants

Mechanisms to prevent reflux of gastric contents include normal peristalsis of the esophagus, saliva flushing, and anatomical structures at the junction of the esophagus (lower esophageal sphincter, mucosal flap at the end of the esophagus, esophageal ligament, abdominal esophageal length, and transverse leg muscle clamp action And the angle between the esophagus and the stomach), when the defense mechanism declines, gastric contents can flow back to the esophagus and cause esophagitis.

Clinical manifestations of gastroesophageal reflux in infants

The clinical manifestations of gastroesophageal reflux in infants and children vary, mainly related to the intensity, duration, complications, and age of the child. Gastroesophageal reflux in infants and young children usually has the following four manifestations:

1. Symptoms caused by reflux

Vomiting is a typical manifestation. Most children have vomiting in the first week after birth. Most children can relieve themselves within 6 months to 1 year without clinical treatment. In fact, this part of children belongs to the category of physiological reflux. No special treatment is required. Only a few children showed repeated vomiting, which gradually worsened. Older children may have acid reflux and snoring.

2. Symptoms caused by reflux stimulating the esophagus

The reflux damages the esophageal mucosa and causes it to undergo inflammatory changes. Infants and young children have atypical symptoms, which can be irritable, disturbed sleep, refusing to feed and feeding difficulties, older children can show symptoms such as heartburn, retrosternal pain, swallowing chest pain, and severe cases may vomit blood or spit coffee. Most of these children have anemia.

3. Irritating symptoms other than the esophagus

Some children may experience recurrent cough, asthma, bronchitis, and aspiration pneumonia due to inhaled reflux, and asthma caused by reflux is not seasonal and often occurs at night. In newborns, reflux can cause sudden suffocation and even death. Oral ulcers, dental diseases, otitis media, etc. have appeared in some cases, but reflux symptoms are not obvious.

4. Complications and others

(1) Esophageal stenosis: Children often have difficulty swallowing gradually, and have a dry feeling after eating dry food. It is also difficult to develop liquid food. Or food incarceration.

(2) Bleeding and perforation: Reflux esophagitis can cause a small amount of bleeding, and some manifestations are occult blood positive or iron deficiency anemia, and large amounts of bleeding can occur during diffuse esophagitis or esophageal ulcers. Occasionally, severe esophagitis or Barrett's esophageal ulcer may be accompanied by esophageal perforation.

(3) Barrett's esophagus: It is a complication of chronic chronic gastroesophageal reflux. The symptoms are dysphagia, chest pain, malnutrition and anemia. Some of these children can develop esophageal cancer.

(4) Growth retardation and anemia: Insufficient feeding due to feeding difficulties caused by vomiting and esophagitis, resulting in malnutrition and growth retardation are important complications of GERD in infants and young children. Severe esophagitis can cause chronic hemorrhagic anemia.

Gastroesophageal reflux examination

Esophagus barium meal angiography

Applicable to any age, but should be cautious for premature infants with gastric storage. The degree of gastroesophageal reflux seen on the X-ray is not parallel to the severity of reflux esophagitis. Fasting for 3 to 4 hours before the test, barium is given in relatively normal amounts in divided portions, and if reflux occurs more than 3 times within 5 minutes, a diagnosis can be made.

2. Esophageal manometry

Esophageal manometry has become a widely used technique for monitoring esophageal function, evaluating diagnosis and treatment. For children with normal lower esophageal sphincter function, 24-hour continuous pressure measurement should be performed to dynamically observe esophageal function and movement.

3. Esophageal pH monitoring

The 24-hour pH monitoring of the lower end of the esophagus has a higher sensitivity and specificity in diagnosing gastroesophageal reflux, and is the preferred diagnostic method. Under normal circumstances, there is no reflux during sleep. The total reflux time is <4% of the monitoring time, the average reflux time is <5 minutes, and the average clearance time is <15 minutes.

4. Esophageal endoscopy

This is the most suitable method for determining esophagitis. Combined with pathological examination, it can reflect the severity of esophagitis, but this method cannot reflect the severity of reflux. It only reflects the severity of esophagitis, and it is a judgement for mild (grade ) esophagus. Inflammation is difficult. Therefore, most scholars have suggested that endoscopy does not require a mucosal biopsy for grade or esophagitis. Rubin tube suction biopsy is only performed when the microscopy is not obvious or there are suspicious changes, but in principle it is not done in the neonatal period. Mucosal biopsy is also the main basis for the diagnosis of Barrett's esophagus.

5. Isotope scanning

The child swallowed or injected the nuclide ^99m Tc calibration solution into the gastric tube, and then periodically performed scintillation scan recording in a quiet state. This test can provide information on the presence or absence of gastroesophageal reflux, observe esophageal function, and allow continuous imaging. At the same time understand the effects of gastric emptying, esophageal clearance, etc., when pulmonary keratin is enhanced, it indicates that reflux is the cause of lung disease.

Diagnosis of gastroesophageal reflux in infants

Clinically, the performance of gastroesophageal reflux in infants and children varies, and a considerable part of gastroesophageal reflux is a physiological phenomenon. The performance of gastroesophageal reflux in children of different ages is different, so objectively and accurately determine reflux and its properties Very important. The diagnosis of gastroesophageal reflux in infants and young children should be based on the following principles: clinically obvious reflux symptoms, such as vomiting, acid reflux, heartburn, or recurrent respiratory infections associated with reflux, etc .; there is clear objective evidence of gastroesophageal reflux .

Gastroesophageal reflux treatment in infants

General treatment

In children, especially neonates, infants, gastroesophageal reflux treatment, body position and diet feeding are very important.

(1) Posture The best position for children is 30 ° in the prone position (including sleep time).

(2) Diet therapy feeding can use thick paste food, small, frequent meals, mainly high-protein low-fat meals, can improve symptoms or reduce the number of vomiting. Drinks should not be taken after dinner to avoid reflux and avoid application of stimulation Sexual condiments and foods and drugs that affect the esophageal sphincter tone.

2. Drug treatment

In the past 10 years, it has developed rapidly. The main drugs are gastrointestinal motility agents and antacids. The combined effect is better for reflux esophagitis. Drug therapy for gastroesophageal reflux has accumulated more experience in adults and older children, but it is only under observation and trial research in the newborn infant period, so the latter should be used with caution.

3. Surgical treatment

It is ineffective for medical system treatment. Patients with serious complications such as esophageal stricture and neurological disorders can consider surgery. Commonly used surgery: Nissen surgery is 360 ° total gastric fundus folding; Belsey 4 surgery is 240 ° anterior gastric wall folding. The short-term effect of surgical treatment is good, but the long-term effect is uncertain.