Gastroesophageal Reflux

Gastroesophageal Reflux is a topic covered in the Select 5-Minute Pediatrics Topics.

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Basics

Description

  • Effortless regurgitation of gastric contents. Occurs physiologically at all ages, and most episodes are brief and asymptomatic
  • Divided into physiologic and pathologic processes:
    • Some degree of physiologic gastroesophageal reflux (GER) is normal at all ages.
    • Physiologic infant reflux (normal GER of infancy) is very common. Symptoms peak around 4 months of age and generally have resolved by 1 year of age.
    • Pathologic reflux or gastroesophageal reflux disease (GERD) is defined by troublesome symptoms or complications of GER.
    • Complications may include reflux esophagitis, bleeding, esophageal stricture, failure to thrive, chronic/recurrent respiratory tract disease, or vomiting.

Epidemiology

Prevalence

  • Pathologic GERD: 10% of adults, 2–8% of children

Risk Factors

  • Neurologic disorders (cerebral palsy/quadriplegia)
  • Esophageal atresia
  • Tracheoesophageal fistula
  • Cystic fibrosis
  • Asthma
  • Gastroparesis
  • Hiatal hernia

Pathophysiology

Transient relaxation of the lower esophageal sphincter during episodes of increased abdominal and gastric pressure. GERD is a multifactorial process involving number of reflux events, acidity, esophageal clearance, gastric emptying, mucosal barriers, visceral hypersensitivity, and airway responsiveness.

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