Gastroesophageal Reflux
Gastroesophageal reflux or GER is the reflux of small amounts of gastric contents into the lower esophagus.
This condition is common among infants. This is primarily a disorder of the lower esophageal sphincter.
GER is a self-limited disease and is seldom found after a child is already in the walking stage.
Clinically, the infant who is feeding well will have regurgitation associated with nausea and vomiting. If the vomiting is not severe, there may be normal growth pattern however, if the vomiting is severe, failure to thrive is observed. Other manifestations seen are:
– esophagitis with or without esophageal strictures
– occult blood loss
– iron deficiency anemia
– hematemesis
– aspiration pneumonia manifested as chronic cough and wheezing
– apneic spells and
– sudden infant death syndrome
It is important to know that there are five grades of GER according to the severity of the reflux:
Grade 1 reflux into the distal esophagus
Grade 2 reflux above the carina
Grade 3 reflux into the cervical esophagus
Grade 4 free reflux with a widely patent LES
Grade 5 reflux with aspiration
Patient’s with GER are given thickened feeds in small volumes. They are also advised to have an upright or elevated position or prone position at a 30 degree angle, appropriate medications like antacids and when these measures fail, then surgery (fundoplication) is warranted.