Gastro-Esophageal Reflux Disease in Healthy Older Children and Adolescents

Abstract

Gastro-esophageal reflux disease (GERD) in otherwise healthy older children and adolescents is commonly encountered in pediatric clinics and poses a complex treatment problem involving changes of diets and lifestyle. After an initial history taking and a physical examination, typical symptoms of GERD in older children and adolescenct are initially treated with the trials of acid suppressants. With an increase of severe cases, more and more GERD children have been evaluated with endoscopy, which helps to delineate an erosive esophagitis from a non-erosive reflux disease as they are presumed to have different pathogenesis. For the pediatric patients without a significant underlying disease, a reflux esophagitis can be treated adequately with acid suppressants. Recently, the rapid increase of children who are taking anti-reflux medication has brought up a serious alarm among pediatricians. Some at risk pediatric patients with recurrent and/or chronic GERD have been linked to adulthood GERD. In this paper, pediatric GERD with and without erosive esophagitis was reviewed along with treatment options and issues specifically for the otherwise healthy older children and adolescents in the primary clinics or the secondary hospitals.

From Newborn to Teenage: Gastroesophageal Reflux

“…It is reported that 5-8.2% of children aged between 10 and 17 years old in the US had at least once had GERD symptoms, while a GERD diagnosis was made in 10.9/1000 patients in the UK. Furthermore, in adult studies, GERD symptoms in Asian countries were below 5%, while they were 10-20% in North America and Western European countries (8). It is reported that the GERD incidence in infants is 12.3% in North America and below 1% in older children (9).…”

“…Particularly, globus sensation and throat clearing movements in older children are important with respect to regurgitation. Respiratory system symptoms related with gastroesophageal reflux may often be related with diseases such as asthma or laryngitis and sinusitis (1,6,8). The coexistence of asthma and GER has been known for many years.…”

“…The reasons increasing the intraabdominal pressure, such as cough; constipation; intraabdominal mass; convulsion; tightly dressing; distention; functional and anatomical reasons, such as neuromuscular disorder, obesity, some genetic syndromes; esophageal atresia operation' scoliosis; chronic pulmonary infection; and preterm labor history increase the risk of GERD compared to in healthy children (1,8,12). While overeating; eating late at night; consuming fizzy drinks; and fatty, salty, and spicy food intake in older children increase reflux; caffeine, nicotine, some drugs (nitrates, theophylline, β adrenergic agonists, α adrenergic agonists, dopamine, calcium canal blockers), and feeding with cow milk in infants cause reflux by decreasing LES pressure (1).…”

“…Stretching of the fundus leads to TLESR, stimulating the vagosympathetic reflex. Transient lower esophageal sphincter relaxations are triggered by a right-side lying position, the presence of a nasogastric tube, and bloating after meals (1,7,8). Four major mechanisms prevent the occurrence of GER in physiological conditions.…”

“…According to PPI, it is used against GERD symptoms, although it is weaker both with regard to the regression of symptoms and the recovery of esophagitis. Side effects such as irritability, hitting the head, headache, and somnolence can occur (1,2,7,8).…”