Chapter 29 Gastroesophageal Reflux
PATHOPHYSIOLOGY
Considered as one of the vomiting disorders, gastroesophageal reflux (GER) is the retrograde passage of gastric contents into the esophagus, the upper airways, and the tracheobronchial area. Predisposing factors associated with GER are (1) muscle tonicity of the lower esophageal sphincter (LES); (2) age; (3) hiatal hernia, (4) intraabdominal pressure; (5) length of the esophagus below the diaphragm; (6) rate of gastric emptying; (7) drugs; (8) hormones; and (9) spontaneous relaxation of the LES secondary to neurologic involvement. Associated symptoms are pain and/or irritability, spitting up, regurgitation of food (especially of liquid to semiliquid consistency), vomiting, poor weight gain, and respiratory disorders. The reflux of gastric contents can lead to apneic spells in young infants and inflammation, damage (Barrett’s esophagus) and stricture of the esophageal mucosa, failure to thrive, occult blood loss, anemia, aspiration pneumonia with or without wheezing, ear and sinus infection, and sleep disorder. In 85% of infants with GER, the condition is self-limiting, disappearing between ages 6 and 12 months; thus resolution of GER is often a maturational process. However, a child may require surgery (gastric fundoplication; see Medical Management in this chapter) if he or she does not respond to medical management.
LABORATORY AND DIAGNOSTIC TESTS
1. Esophageal pH measurement (less than 4.0 is diagnostic) for 23 hours
2. Electric impedance measurement
3. Endoscopy—to detect presence of gross and microscopic esophagitis and cellular dysplasia
