Paediatric Reflux

From MedRevise
Jump to navigation Jump to search

Definition

Gastro-oesophageal reflux is the reflux of stomach contents into the oesophagus. Oesophagitis is inflammation of the oesophagus.

Epidemiology

Common.jpg

Over half of babies experience reflux in the first three months of life with the vast majority resolving by 1 year. It can however become severe but this is in the small minority of cases.

Pathophysiology

In the normal upper GI tract the lower oesophageal sphincter closes to prevent stomach contents from going back into the oesphagus. In reflux, the infant sphincter has not yet fully developed and hence cannot contain the contents of its stomach.

Clinical Features

Regurgitation and distress after feeds are the most usual symptoms. The more serious ones are:

  • Apnoea
  • Failure to thrive
  • Dehydration
  • Pneumonia symptoms (SOB, cough, fever) due to potential aspiration pneumonia

Essentially, what you are trying to determine quickly is whether the child is at risk due to poor feeding. Dehydration and failure to thrive are both worrying signs in terms of feeding. Overfeeding needs to be ruled out so take a good feeding history

Investigations

Generally speaking, no investigations are needed if the symptoms are merely regurgitation or mild distress after feeding. If pneumonia or more serious conditions are suspected:

Bloods

  • FBC - anaemia (Hb↓) and infection (WCC↑)
  • U&Es - dehydration (deranged electrolytes) and malnutrition (Urea↓)

Imaging

  • CXR - aspiration pneumonia

In serious disease may require endoscopy but this should only be used when basic management has failed.

Management

Antacids are the mainstay of reflux management. Gaviscon is the most commonly used for and can be given in various forms. 1 dose of Infant Gaviscon is mixed with 15ml of water (boiled, then cooled) forming a paste given following breast-feeding. Bottle-fed infants should have it dissolved in their mix. Gaviscon also contains an alginate which thickens feeds, making reflux less likely.

Domperidone+/- omeprazole is another treatment which can be used. Domperirdone is anti-emetic and omeprazole a proton-pump inhibitor.

In serious disease, not resolved by 6-9 months with failure to thrive, severe oesophagitis, anaemia or bleeding, consider fundoplication. This is a surgical procedure where the fundus of the stomach is wrapped around the lower end of the oesophagus and stitched in place. The musculature of the fundus then prevents further reflux.

Prognosis

Few infants have problems past the age of 12 months and very few have to have surgery to resolve symptoms anyway.