Gastroesophageal reflux disease in children

Gastroesophageal reflux disease in children is a chronic disease caused by the regular casting of the contents of the stomach or duodenum into the lumen of the esophagus. Heartburn, eructation, violation of swallowing processes are the main signs of GERD. The scheme of treatment of the disease depends on the severity of the pathology and age of the child.

Causes of the disease

Gastroesophageal reflux disease in childhood is a direct consequence of gastroesophageal reflux. The condition is a pathological throw of the contents of the stomach into the lumen of the esophagus, which provokes a change in the state of the mucosa. The main causes of gastroesophageal reflux are:

• insufficiency of the lower sphincter of the esophagus;
• decrease in esophageal clearance (speed of esophagus discharge);
• violation of the motility of the stomach and the gastrointestinal tract.

Provoke the development of such conditions are capable of deviations in the work of the autonomic nervous system, obesity, diaphragmatic hernia. As an initiating factor in GERD, unbalanced nutrition, increased gastric juice production, frequent increase in intra-abdominal pressure caused by constipation, increased gas production, etc., pathology of the respiratory system, treatment with certain groups of medicines may be involved.

Classification of the disease

The classification is based on the degree of lesion of the esophagus mucosa and the strength of extraesophageal symptoms. Distinguish between gastroesophageal reflux disease without esophagitis and GERD with esophagitis. In the latter case, the disease has 4 stages:

• The first. It is accompanied by local redness and swelling of the mucous surface.
• The second. The total puffiness is diagnosed, the presence of localized areas with fibrous plaque, eroded areas is determined.
• The third. The number of erosions, located on different parts of the esophagus, increases.
• Fourth. It is accompanied by the formation of bleeding ulcers, pronounced narrowing of the esophagus and the formation of Barrett's esophagus.

Barrett's esophagus - one of the complications of the disease

The third type of disease - GERD, accompanied by a violation of the motor of the cardiac (distal) esophagus. Has three degrees, which are denoted by the letters A, B, C. "A" is expressed in a moderate disruption of the closing sphincter, its short-term opening by 1-2 cm.

"B" - at this stage, more pronounced signs of sphincter deficiency are detected, opening occurs at 3 or more centimeters. "C" is characterized by signs of significant insufficiency of the cardiac sphincter of the esophagus, its prolonged opening above the diaphragmatic legs.

Symptomatology

Symptoms of GERD are divided into two groups. The first includes signs associated with the work of the digestive tract - esophageal ones. The second - extra-vascular - is not associated with the activity of the gastrointestinal tract. In infants and young children of preschool age, the main symptom of the disease is vomiting, regular regurgitation and poor weight gain. Sometimes vomit includes veins of fresh blood.

In children of the older age group and adolescents, a clear clinical picture of abnormalities in the functioning of the gastrointestinal tract is monitored in the development of GERD. Most often, dysphagia (a violation of swallowing) and severe heartburn are recorded. Regardless of age, the child may have insomnia, dependence on the weather, headaches, unstable emotional state.

Esophageal manifestations are caused by the direct transfer of gastric contents into the lumen of the esophagus. These include:

• heartburn;
• belching with a sour or bitter aftertaste;
• syndrome "wet spot" - the appearance on the pillow of the whitish trace, due to increased production of saliva during sleep and its free flow;
• soreness behind the breastbone during meals (lonely);
• feeling of a coma in the chest, arising during the meal.

One of the potential signs of GERD is a violation of appetite

Extra-oesophageal symptoms are divided into several groups.

• Broncho-pulmonary manifestations. Seventy percent of all diagnoses of GERD are recorded. It appears in the form of bronchial asthma, bronchial obstructive syndrome (manifested as a night paroxysmal cough, shortness after eating). In most cases, they are supplemented with heartburn and eructations.
• Otolaryngological manifestations. Presented in the throat, stuck food during passage through the throat, hoarseness of the voice, a feeling of squeezing in the neck. It is not excluded soreness in the ears.
• Cardiac manifestations. Against the background of GEB, the child has sinus arrhythmia, extrasystole.

Possible complications

Transition of the disease into a chronic form and the lack of adequate therapy in children can cause serious complications. This pathological narrowing of the esophagus, posthemorrhagic anemia, Barrett's esophagus.

Esophagus stenosis

The condition is caused by abnormal narrowing of the esophageal tube caused by changes in the mucous membrane. The cause is scarring of ulcerous areas. Against the background of the chronic course of the disease and the accompanying inflammatory process, there is involvement of the near-esophageal tissues. The child forms a pereezophagitis.

Posthemorrhagic anemia

The pathology is caused by prolonged bleeding from the eroded parts of the epithelium, or as a result of the entrapment of the intestinal loop in the diaphragmatic opening. With GERD, the following types of anemia can develop: normochromic, normoregeneratornaya, normocytic. In the analysis of blood there is a slight decrease in serum iron.

Barrett's esophagus

Refers to precancerous conditions. For him, typical replacement of flat multilayered epithelium with cylindrical, which is typical for the stomach and intestines. There are approximately 14% of all diagnoses of GERD. Almost always there is a degeneration into adenocortical or squamous cell carcinoma.

Diagnostic measures

Diagnosis of gastroesophageal reflux disease includes not only the study of anamnesis and the collection of complaints, but also the conduct of laboratory and instrumental studies. As a rule, a pediatrician from a survey of a child or his parent receives information about the available dysphagia, the symptom of a "wet spot". This is enough for a preliminary diagnosis.

A blood test can show the following deviations: a low level of erythrocytes and hemoglobin - indicates the presence of posthemorrhagic anemia, neutrophilic leukocytosis or a shift to the left of the leukocyte formula - typical for bronchial asthma.

To diagnose GERD, the following instrumental techniques are used:

• Intraesophageal pH-metry. The study helps to identify GERD, determine the causes of its development, assess the lesion of mucous surfaces.
• EGDS (mandatory procedure). It provides an opportunity to identify the presence / absence of esophagitis, the degree of its severity, and motor GI disorders.
• X-ray with contrast agent. Helps to identify reflux and a disease that provokes its development.
• Biopsy. Appointed for suspected Barrett's esophagus.

If necessary, such studies as ultrasound, scintigraphy, impedanceometry, esophageal tube manometry may be prescribed.

Treatment of the disease

Treatment of GERD in children is carried out in three directions. This is non-drug therapy, medication, surgery. The treatment protocol is based on the age of the child and the severity of the current condition. Children of younger preschool age practice a non-drug approach. Its essence lies in the special way of feeding the baby, as well as sleep in the elevated position of the upper body.

The possibility of taking medicines is considered individually. The appointment is affected by the severity of the pathology and the current state of health of the baby. When drawing up a treatment plan for the disease in children of the older age group, the severity of GERD and the complications are taken into account. Non-drug treatment involves compliance with the principles of dietary nutrition and lifestyle in general.

Recommendations of doctors: sleep with a raised head (the height of the pillow should be 14-20 cm), the normalization of the weight of the child in the presence of signs of obesity, exclusion from the diet of products that can raise the level of intra-abdominal pressure. Medicamentous treatment is carried out with the help of the following groups of medicines:

• proton pump stimulants;
• prokinetics;
• antacids;
• drugs that normalize intestinal motility.

The combination of drugs and the regimen of admission in each case are selected individually, depending on the form of the disease and its severity. More information about the drugs used in the treatment of GERD, read here. The disease can be treated surgically. Operative intervention is practiced in the absence of a result in the previously prescribed scheme of drug treatment.

Indications are also the formation of complications, the combined course of GERD and diaphragmatic hernia. For the most part, Nissen's fundoplication is carried out, Dora's method is more rarely practiced. If the medical institution has the necessary equipment at its disposal, the operation is performed in a laparoscopic way.

Diet

Revision of the child's diet helps alleviate the symptoms of the disease. For babies, the recommendations are as follows:

• after feeding the crumb should be held in an upright position for about half an hour;
• during feeding with a bottle, you need to make sure that the nipple is always filled with milk - then the baby can not swallow a large amount of air;
• in the composition of complementary foods, it is recommended to introduce a small amount of rice porridge;
• During feeding, the baby should regurgitate several times in order to get rid of excess air.

Tips for older children:

• it is necessary to limit or completely eliminate fried (fatty) dishes (foods), chocolate, sweet sodas, caffeinated drinks, citrus fruits, fruit juices, tomatoes;
• reduce the size of a portion, avoiding overeating;
• dinner should be held 3 hours before going to bed.

ethnoscience

Folk recipes can be used successfully as aids. Special benefits will be brought by teas on herbs. In childhood, it is allowed to practice the following recipes. It is necessary to combine the seeds of flax, the root of licorice, the grass of mother-and-stepmother in equal amounts. 1 tbsp. l. mix boil with boiling water (250 ml) and warm in a water bath for 15 minutes.

Mix equal parts of the root of the althaea and the herbs of thyme. 2 tbsp. l. Collect pour boiling water (250 ml) and insist 2 hours. Combine mint (2 parts), valerian (2 parts) and celandine (1 part). 1 tbsp. l. of the composition, pour boiling water (250 ml) and pour on the water bath for 15 minutes. Before using the product, it needs to be filtered out. Give 1 tbsp. l. before meals.

A good therapeutic effect shows honey water. For its preparation it is desirable to use flower honey. In 85 ml of warm water, stir 1 tbsp. l. product. Drink the resulting drink on an empty stomach or between feedings. Treatment with herbs is carried out by courses. Duration of each - 2 months with a break of 3 weeks. The total duration of therapy is 1 year.

The drug course with GERD can be supplemented with folk recipes

Prognosis of the disease

The prognosis of GERD in childhood is favorable. But with the development of complications in the form of Barrett's esophagus, the probability of degeneration remains. The formation of a precancerous state in childhood is very rarely diagnosed. According to statistics, in 30% of small patients with a similar diagnosis within the next 50 years squamous cell carcinoma or adenocarcinoma is formed.

Prevention of GERD

Warn the development of pathology in children can. The recommendations will be as follows: proper nutrition, elimination of causes that cause an increase in intra-abdominal pressure, refusal to take medications that can cause the development of reflux.

Gastroesophageal reflux in children is a serious pathology requiring compulsory treatment. That is why when a characteristic symptomatology of the child appears, it is necessary to show the specialized specialist and undergo a course of drug therapy.