From Newborn to Teenage: Gastroesophageal Reflux

Abstract

Gastroesophageal reflux (GER) is characterized by the involuntary passage of gastric contents into the esophagus. GER disease is defined as a persistent or intermittent passage of gastric contents into the esophagus, which often results in overt clinical signs and symptoms and affects the quality of life. GER is a common disorder in childhood and has a good prognosis. GER in infancy begins within the first month of life, peaks at the 4 th month, and after the first year, it steadily decreases and finally resolves at the age of 2 years. GER physiologically occurs due to the relaxation of the lower esophageal sphincter, independent of swallowing. The mechanisms against GER include the following; 1. Lower esophageal sphincter dysfunction, 2. Clearance effect of esophagus, 3. Esophageal mucosal integrity, and 4. Gastric emptying, which prevent the development of GER disease. Although the physiopathology of GER is still not clearly established, proposed factors are genetic, environmental, anatomic, hormonal, and neurogenic. The most responsible factor is lower esophageal sphincter relaxations. The clinical signs of GER varies with age but commonly appear with gastrointestinal and respiratory symptoms. The diagnosis of GER disease is based on history, physical examination, esophageal pH monitoring, multichannel intraluminal impedance and esophageal manometry, motility examinations, endoscopy, biopsy, examinations with barium, and nuclear scintigraphy. Treatment of GER includes non-pharmacological and pharmacological therapies, such as prokinetic agents and acid suppressors. Surgical treatment indications are relatively limited. (JAREM 2016; 6: 67-73)