Gastroesophageal Reflux

Gastroesophageal Reflux is a topic covered in the 5-Minute Pediatric Consult.

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Basics

Description

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

Epidemiology

Pathologic GERD occurs in 5% of adults; 1–4% of children

Risk Factors

  • Neurologic disorders (cerebral palsy/quadriplegia)
  • Congenital esophageal disorders
  • Midgut or diaphragmatic defects
  • 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 that is mediated by the number and frequency of reflux events, relative acidity, potential for esophageal clearance, delay in gastric emptying, effectiveness of mucosal barriers, degree of visceral hypersensitivity, and airway responsiveness.

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