Gastroesophageal Reflux Disease
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Reflux of gastroduodenal contents into the esophagus, larynx, or lungs, with or without resultant esophageal inflammation
Symptoms (vomiting, weight loss, failure to thrive) usually resolve by 18 months.
Children affected: 1/300–1,000
- Prevalence of gastroesophageal reflux disease (GERD): 10–20% in the US
- Prevalence of Barrett esophagus: 1.5%
- 65% adults have had heartburn; 15% have weekly symptoms
- In a European population-based study, reflux symptoms were found only in 40% of subjects with Barrett esophagus, and in 1/3 of patients with documented esophagitis.
- Alcohol use
- Caffeine use
- Position of the acid pocket above the diaphragm in patients with hiatal hernia (see below) (1,2)
Gene polymorphism identified
Positional treatment: Use infant seat for 2–3 hours after meals; thickened feedings:
- Avoid alcohol, nicotine, and caffeine.
- Avoid lying down immediately after a meal.
- Elevate head of bed.
- Occurs with loss of the normal pressure gradient between the lower esophageal sphincter (LES) and the stomach
- Most commonly due to inappropriate relaxation of LES:
- Foods (high fat, spicy, citrus, chocolate, peppermint, onions)
- Medications (anticholinergic, smooth muscle relaxants, i.e., calcium channel blockers, nitrates)
- Other contributing factors include:
- Pregnancy (progestational hormones decrease LES pressure)
- Ineffective peristalsis
- Delayed gastric emptying
- Positional: Recumbency, bending
Commonly Associated Conditions
- Reflux esophagitis: Due to exposure to acid, pepsin; classified as erosive (mucosal damage apparent, ulcers, friability) or nonerosive
- Extraesophageal reflux:
- Chronic cough
- Laryngitis, vocal cord granuloma
- Otitis media
- Hiatal hernia: The position of the acid pocket (the zone of high acidity detected in the proximal stomach after a meal) above the diaphragm in patients with hiatal hernia is a major risk factor (1,2).
- Peptic stricture: In 10% with GERD
- Barrett esophagus
- Esophageal adenocarcinoma