Gastroesophageal reflux

the passage of gastric contents into the esophagus with or without regurgitation and vomiting.The majority of infants, who are otherwise healthy, present with regurgitation or vomiting with no failure to thrive or other associated symptoms. These infants are labeled as ‘happy spitters’. In infants with regurgitation, it is important to differentiate physiological GER from other causes of vomiting and GERD . GER is common in infants but GERD is not so common in early childhood. Most infants have physiological reflux and need minimal intervention as their symptoms resolve by 18 months of age.

when GER leads to troublesome symptoms that affect daily functioning and/or complications. ❖ Weight loss or inadequate weight gain ❖ Crying and fussiness during and after feeding ❖ Emesis and/or hematemesis ❖ Irritability ❖ Anemia ❖ Bad breath, gagging or choking at the end of feeding ❖ Sleeping disturbance and frequent night waking ❖ Abdominal pain ❖ Dental erosion ❖ Dystonic neck posturing (Sandifer syndrome) ❖ Feeding difficulty ❖ Respiratory symptoms (aspiration, apnea, recurrent pneumonia, chronic stridor, wheezing)

Predisposing condition for GERD are
 Obesity
 Neurological impairment like cerebral palsy
 Neuromuscular disease like congenital myopathy
 Genetic conditions like Trisomy 21
 Repaired trachea-esophageal fistula
 Repaired esophageal atresia
 Congenital diaphragmatic hernia
 Chronic lung disease like bronchopulmonary dysplasia, bronchiectasis, asthma
 Cystic fibrosis, scleroderma
 Previous esophageal caustic injury
 Significant prematurity
 Strong family history of GERD, Barrett esophagus or esophageal adenocarcinoma

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