Gastroesophageal reflux disease in pediatrics   

Discuss the gastroesophageal disease of children on Mn580.

Gastroesophageal disease in children

The gastrointestinal disorder Gastroesophageal Reflux Disease (GERD), which is common amongst children, results when stomach contents are refluxed into the esophagus. GERD symptoms can include heartburn, chest discomfort, regurgitation and vomiting. These can affect the children’s quality of life. This paper discusses the pathophysiology of GERD and its symptoms, such as heartburn, chest pain, regurgitation, and vomiting.

Pathophysiology:

In pediatrics, GERD is caused by the relaxing of the lower esophageal sphincter. This sphincter normally stops stomach acid from refluxing into the esophagus. The relaxation can be caused by a decreased LES, an increase in abdominal pressure or a combination. Reflux of stomach contents can result in inflammation and damage to the esophageal lining, leading to symptoms like heartburn and chest pain.

Epidemiology:

GERD affects a large number of children in the United States, where it is prevalent. (El-Serag 2014) It is most common in infants. The prevalence can reach up to 50 percent among babies aged between 0 and 3 months. By the time they turn 10, it drops to just 5% (Rosen, et. al.,2018). GERD also occurs more frequently in children who have other comorbidities such as neurologic or respiratory problems.

Findings from physical examination

GERD symptoms in pediatrics can include dysphagia and regurgitation. Feeding difficulties, irritability and failure to grow may be present in infants. A physical examination can reveal signs such as edema or erosions on the mucosa.

Differential diagnosis and their rationale

Other gastrointestinal disorders such as eosinophilic esophagitis and achalasia as well as other non-gastrointestinal conditions such as heart and pulmonary diseases can be considered as differential diagnoses of GERD. To confirm the diagnosis, a thorough examination is required to exclude these conditions.

Management plan:

In pediatric GERD, a multidisciplinary management approach is used, which includes lifestyle changes, pharmacologic treatment, and in certain cases surgical intervention. To confirm the diagnosis, and to assess the severity, diagnostic testing may be required, such as upper endoscopy or pH monitoring. Proton pump inhibitors, histamine-2 antagonists (H2RAs) and prokinetics are used to treat GERD among children. To monitor response to treatment, and to adjust management plans as required, follow-up programs should be implemented. A referral to a pediatric gastroenterologist for further assessment and treatment may be required.

GERD, a common pediatric disorder, can cause a variety of symptoms including regurgitation and vomiting. It is believed that the pathophysiology behind the disorder involves the relaxing of the lower-esophageal muscle, leading to the regurgitation of stomach contents. For the treatment of GERD among children, a multidisciplinary strategy is required, involving lifestyle modification, pharmacological therapies, and in some cases surgical intervention. To rule out any other possible diagnoses, a thorough assessment is required. Follow-up plans are also necessary to track the patient’s response to treatment.