Gastroesophageal Reflux in Critically Ill Children: A Review

Abstract

Gastroesophageal reflux (GER) is very common in children due to immaturity of the antireflux barrier. In critically ill patients there is also a high incidence due to a partial or complete loss of pressure of the lower esophageal sphincter though other factors, such as the use of nasogastric tubes, treatment with adrenergic agonists, bronchodilators, or opiates and mechanical ventilation, can further increase the risk of GER. Vomiting and regurgitation are the most common manifestations in infants and are considered pathological when they have repercussions on the nutritional status. In critically ill children, damage to the esophageal mucosa predisposes to digestive tract hemorrhage and nosocomial pneumonia secondary to repeated microaspiration. GER is mainly alkaline in children, as is also the case in critically ill pediatric patients. pH-metry combined with multichannel intraluminal impedance is therefore the technique of choice for diagnosis. The proton pump inhibitors are the drugs of choice for the treatment of GER because they have a greater effect, longer duration of action, and a good safety profile.

Indicadores antropométricos em crianças e adolescentes com doença do refluxo gastroesofágico atendidos em um ambulatório especializado em São Luís, Maranhão, Brasil

“…Os sintomas mais prevalentes neste estudo demonstram-se compatíveis com o diagnóstico de DRGE 13,14 . Tais sintomas são comuns na infância, de modo que essa situação foi denominada de regurgitação infantil (RI) e deve ser diferenciada do refluxo gastroesofágico patológico (RGEP).…”