Gastroesophageal reflux (GER, aka acid reflux or acid regurgitation) occurs when the opening to the stomach (lower esophageal sphincter, LES) doesn't close properly, causing food and digestive acid to rise up the esophagus. This stomach acid irritates and inflames the esophagus causing heart burn pain (esophagitis).
Persistent acid reflux is considered Gastroesophageal Reflux Disease (GERD), and it can eventually lead to more serious health problems including chronic esophagitis, causing pain and trouble swallowing. When gastroesophageal reflux results in persistant vomiting the vocal cords and small airways of the lung can become irritated leading to recurrent pneumonia, and breathing problems which can be mistaken for asthma.
Pediatric patients with gastroesophageal reflux have problems with irritability, poor feeding, slow growth, and respiratory trouble. For children with esophageal birth defects, gastroesphageal reflux is common and may contribute to the formation of esophageal narrowing or stricture, which makes swallowing difficult.
Diagnosis of gastroesophageal reflux
If gastroesophageal reflux is suspected, additional tests may be performed to test the severity of the condition:
Upper gastrointestinal (GI) contrast study
24-hour pH monitoring
Upper GI endoscopy (direct telescopic visualization)
Gastric emptying studies.
The type of studies performed depend on your child's specific symptoms and condition. It is also important to determine if the GER is caused by some other condition, including esophageal or diaghragmatic birth defects.
Treatment of gastroesophageal reflux
Medical non-operative treatment
Initial treatment for GER is usually medical non-operative treatment. In infants, this includes upright positioning and thickened feedings with or without the addition of medicine that helps the stomach empty (Reglan®). Most infants respond to medical treatment and do not require a surgical procedure. H 2-blockers, such as cimetidine or ranitidine, also may improve the success of non-operative therapy. Proton-pump inhibitors (e.g., omeprazole, Prevacid®) have revolutionized medical therapy and are effective agents for non-operative treatment of this disorder.
Surgical intervention may be considered if medical therapy was unsuccessful or if additional complications occur. With some esophageal birth defects, gastroesophageal reflux is a common problem and surgical intervetion is often neccessary.
The goal of a fundoplication is to prevent stomach contents from returning to the esophagus. This operation is accomplished by wrapping the upper portion of the stomach around the lower portion of the esophagus, tightening the outlet of the esophagus as it empties into the stomach. After a fundoplication, food and fluids can pass into the stomach but are prevented from returning to the esophagus and causing symptoms of esophageal reflux. A large skin incision may not be required. In most cases, a fundoplication can be performed by a pediatric surgeon using a small telescope and miniaturized instruments placed through three to four band-aid sized incisions on the abdomen.
For more information, on treatment for gastroesophgeal reflux visit: Fundoplication