The rationale of using prokinetic agents in GERD therapy relies on the evidence that these agents, by increasing gastric emptying rates, might reduce transient lower esophageal sphincter relaxation. However, all these therapeutic agents are associated with significant side effects, including extrapyramidal reactions and heart dysrhythmia; hence their use is currently not recommended [80,81]. Figure 1 summarizes the clinical management of GERD in infants according to current guidelines .
What causes reflux?
Medication may still be the best option for infants with severe symptoms. On the contrary, older children and adolescents tend to resemble their adult counterparts, complaining of more classical symptoms of heartburn and acid regurgitation , making a clinical diagnosis of GERD more consistent, in terms of specificity and sensitivity. However, the reported specificity and sensitivity of symptoms-based questionnaires varies widely and is estimated to be 70% and 65%, respectively, in adult patients with reflux disease .
Find out more about the link between acid reflux and sore throat, what causes it, how to treat it or relieve symptoms at home, how it can affect children, and how to distinguish this from other types of sore throat. Medications that might be prescribed include H2 blockers and proton pump inhibitors (PPIs). These medications ease symptoms of GERD by lowering acid production in the stomach and can help heal the lining of the food pipe. H2 blockers are usually used for short-term or on-demand relief and PPIs are often used for long-term GERD treatment. Sometimes, a more severe and long-lasting form of gastroesophageal reflux called gastroesophageal reflux disease (GERD) can cause infant reflux.
How do doctors diagnose reflux and GERD in infants?
Antacids are generally avoided in babies because of the lack of efficacy and risk of toxicity. H2 blockers are pretty safe but lose effectiveness after a few weeks.
This treatment has been largely replaced by medication. Vagotomy by itself tended to worsen contraction of the pyloric sphincter of the stomach, and delayed stomach emptying.
Although the authors showed similar numbers of proximal reflux episodes (i.e., reflux events reaching one or two most proximal impedance channels) in patients with GERD-related respiratory symptoms compared to children with GERD presenting with only gastro-intestinal (GI) symptoms , significantly higher numbers of weakly alkaline reflux in the study group (children 1 year of age with reflux-related respiratory symptoms) rather than acid reflux were seen. This supported the hypothesis that reflux acidity is not the main cause of respiratory symptoms and therefore the treatment based on acid suppressants is less effective in this group of patients . Gastro-esophageal reflux (GER) refers to the involuntary passage of gastric contents into the esophagus. In children, it often represents a physiological phenomenon, especially in infants with innocent regurgitation. Conversely, GER disease (GERD) occurs when the reflux of gastric contents causes troublesome symptoms and/or complications.
In another study, although there appeared to be a significantly higher prevalence of asthma in children with GERD presenting with respiratory symptoms compared to subjects presenting with GI symptoms only (35.3% vs. 5.3%, respectively), the overall prevalence of asthma in patients with and without GERD was similar . Therefore, although an association between asthma and GERD is advocated, the cause-effect relationship needs further elucidation. Certain conditions exist, which predispose to severe, chronic GERD.
Esophageal monitoring. This is a way to measure acid levels in your lower esophagus for 24 hours. 7. Neu M, Corwin E, Lareau SC, Marcheggiani-Howard C. A review of nonsurgical treatment for the symptom of irritability in infants with GERD. We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (immaturity), disturbance of the microbiome (caesarean section) and mental health (maternal anxiety in particular).