Acid reflux in children ( GERD ) : causes, symptoms , diagnosis, treatment
Gastroenterology / / May 01, 2016
Gastroesophageal reflux disease (GERD) - a chronic relapsing disease caused by the spontaneous, regularly repeated reflux, reflux promotion content stomach or duodenum, through the lower esophageal sphincter, back into the esophagus.Reflux occurs when the muscle activities of the lower esophagus or other protective mechanisms fail.
distinctive feature of GERD symptoms are:
- heartburn - a burning sensation in the chest and throat;
- regurgitation - a burning sensation from the accumulation of acid in the esophagus.Although
acid is the main factor of the damage caused by GERD may also be other harmful products of the gastrointestinal tract, including pepsin and bile.
Heartburn - a condition in which acid from the stomach travels back into the esophagus, causing pain in the chest.Reflux typically is because the sphincter muscle between the esophagus and the stomach weakened.Vertical position standing or sitting after meals can help reduce reflux which causes heartburn.Con
esophagus - is a narrow muscular tube length of 25-30 cm It starts under the tongue and ends at the stomach..esophageal tube ?? narrow in the upper and lower parts, but in the middle of it - slightly narrowed.
esophagus consists of three main layers:
- the outer layer of fibrous tissue;
- the middle layer containing smooth muscle;
- the inner membrane, which contains many tiny glands.
When a person ingests food, the esophagus moves it in the stomach under the influence of wave-like muscle contractions - peristalsis.The stomach acid and enzymes destroy various starch, proteins and fats from food.The mucous membrane of the stomach has a thin layer of mucus that protects it from these liquids.
After a person swallows, the sphincter opens and the food enters the stomach.It then immediately closes to prevent regurgitation of stomach contents including stomach acids.NPC supports this barrier pressure for food, that it is not swallowed again.If the barrier is not enough pressure to prevent regurgitation, and if acid reflux support, esophageal peristaltic action serves as an additional protective mechanism, pushing back up the contents back into the stomach.If
acid and enzymes go back into the esophagus, it gives only weak lining protection against these agents.Instead, there are other factors to protect the esophagus.The most important structure for this just serves as the lower esophageal sphincter (LES) - a group of circular muscles around the lower part of the esophagus, on the border with the stomach.Typically, when the food or liquid to enter the stomach, LES closes the esophagus.If the NPC does not close tightly enough after cooking, going to the stomach, the stomach contents can back up (reflux) into the esophagus.This partially digested material can irritate the esophagus, causing heartburn and other symptoms.
Causes of heartburn and gastroesophageal reflux disease in children
GERD is very common in children of all ages, but it is usually mild forms.Symptoms usually appear better than the majority of children under the age of 12 months.Children with the following conditions are at higher risk of severe GERD:
- neurological disorders;
- food allergy;
- cyclic vomiting;
- cystic fibrosis;
- problems in the lungs, ears, nose and throat;
- any disease affecting the gastrointestinal tract.
Symptoms of heartburn and gastroesophageal reflux disease in children
Typical symptoms in children include:
- frequent regurgitation;
- bending the back;
- choking or nausea;
- feeding resistance.
physician should as soon as possible to examine any child severe GERD symptoms because these symptoms may indicate complications such as anemia, failure to gain weight, respiratory problems.
severe GERD symptoms in infants and young children may include:
- developmental delay;
- chronic cough;
- frequent infections;
- gasping or frequent pauses in breathing during sleep (sleep apnea);
- severe vomiting - particularly if it is green (bile) - always requires a visit to the doctor because it may be a symptom of severe obstruction.
However, in infants and older children, such problems can occur without GERD.
complications of heartburn and gastroesophageal reflux disease in infants and children
Children with GERD, as a rule, refuse to eat and can not eat solid foods for the first few years.
Communication with asthma and infections of the upper respiratory tract.In addition to asthma, GERD may be associated with other problems of the upper airways, including ear infections and sinusitis.
Rare complications in children.While GERD in children is very common, these complications occur only rarely:
- developmental delay;
- anemia due to feeding problems of food and liquids;
- stomach acid, which is inhaled into the respiratory tract and cause pneumonia in children.
child's life may be in danger if the acid reflux causes severe spasms in the throat, blocking the airway.Some experts believe that such a chain of events may contribute to sudden infant death syndrome (SIDS).However, more research is needed to determine whether there's a connection.
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treatment of heartburn and gastroesophageal reflux disease in children and infants
Here are some tips for managing GERD in infants:
- During and after feeding children should be in the upright position andoften spit up.
- Tilt the child with GERD up to prevent or reduce gastroesophageal reflux while the child is in bed.Parents of children with GERD should discuss the child's sleeping position with your pediatrician.Sitting position should be avoided, if possible.Experts strongly recommend that all healthy infants sleep on their backs to help prevent SIDS.However, in children with GERD lying on the back can be an obstacle to the respiratory tract.If your doctor recommends that a child was sleeping on his stomach, parents should be sure that the baby mattresses - very hard and probably at the head tilted up, and that there are no pillows.The baby's head should be turned so that the mouth and nose did not hurt.Closely supervise children when they are lying on your stomach.
- Due to the fact that food allergies can cause in children with GERD, parents can discuss the diet plan with your doctor, who starts to enter the baby formula with the use of non-allergenic proteins, and then gradually add other foods until the symptoms disappear.
- Proton pump inhibitors (proton pump - IPP) - such as omeprazole (Prolisek) and lansoprazole (Prevasid) - drugs that suppress the production of stomach acid.Approved esomeprazole (Nexium) injections for the treatment of GERD with erosive esophagitis children older than 1 month, at which it is impossible oral (by mouth) medicating.
The same drugs used adults with chronic GERD.Although some drugs are available over the counter, they do not give to children without medical supervision.
- Changes in diet may include the removal of products - acidic or possibly related to reflux (such as: tomatoes, chocolate, mint, juice, sodas with caffeine - Black tea, coffee).
Obese children should certainly try to lose weight.
- Milder preparations - such as antacids - used first.However, prolonged use of these drugs is not generally recommended because of their side effects (diarrhea or constipation).
- PPIs can be effective also for children.Capsules and liquid APIs have been approved for short-term (up to 8 weeks) treatment of GERD in children aged 1-11 years.The most common side effects of this are: headache, diarrhea, abdominal pain, nausea, gas, constipation, dry mouth and drowsiness.Nexium capsules were previously approved for use for children aged 12-17 years, as well as for short-term treatment of GERD.Rabeprazole (Asifeks) - is intended for short-term (up to 8 weeks) treatment of adolescents aged 12 years and older.PPIs seem to be safe and effective, even for children under the age of 1 year, with no less intensive care.However, children who received H2 blockers and proton pump inhibitors, may be at increased risk of developing respiratory and intestinal infections.
- Surgical fundoplication in children involves wrapping the upper curve of the stomach around the esophagus.The goal of this surgical technique is to strengthen the NPC.Until recently, surgery was not the main treatment of children with severe complications of GERD, becausean old drug therapy had serious side effects, it was ineffective or has not been designed for children.Nevertheless, when administered IPP some children may avoid surgery.Surgical fundoplication can be performed laparoscopically, through small incisions .