GERD and LPR

What are the differences between GER and GERD?

When this movement of fluid triggers symptoms that are bothersome, GER becomes gastroesophageal reflux disease (GERD). Despite the high prevalence of the disorder, GERD still represents a challenge, even for the experienced clinician. In pediatric populations, this is particularly evident due to the multifaceted clinical presentation and the frequent occurrence of regurgitation in “well infants”. There have been many efforts thus far to appropriately select patients for investigation and treatment and current guidelines represent the state-of-the-art approach to patients with suspected GERD. The recommended approach to adolescents complaining of typical GERD is similar to that of adults, encompassing lifestyle changes and a four-week trial with PPIs.

The procedure can be done with laparotomy, thoracotomy, or laparoscopy. Gastroesophogeal reflux is different from vomiting because usually it is not associated with a violent ejection. Moreover, GER is generally a singular event in time, whereas the vomiting process is commonly several back-to-back events that may ultimately completely empty all stomach contents and yet still persist (“dry heaves”). The difference between GER and GERD (gastroesophageal reflux disease) is a matter of severity and associated consequences to the patient.

What tests do doctors use to diagnose GERD?

Finally, if your child’s esophagus doesn’t move normally, any reflux that enters the esophagus isn’t cleared well, putting children at risk for symptoms and esophageal damage. When acid repeatedly “refluxes” from the stomach into the esophagus alone, it is known as gastroesophageal reflux disease (GERD). However, if the stomach acid travels up the esophagus and spills into the throat or voice box (called the pharynx/larynx), it is known as laryngopharyngeal reflux (LPR). 69.

Despite the immense volume of data examining diagnosis, management and prognosis related to pediatric gastroesophageal reflux, a recent review of 46 articles (out of more than 2400 publications identified) demonstrated wide variations and inconsistencies in definitions, management approaches and in outcome measures. Symptoms abate without treatment in 60% of infants by age 6 months, when these infants begin to assume an upright position and eat solid foods. Resolution of symptoms occurs in approximately 90% of infants by age 8-10 months.

of gestation. Patients with GER and GERD may also benefit from changing body position, by keeping them upright or even in the prone position, especially in the post-prandial period [62,63,64]. However, due to the increased incidence of sudden infant death syndrome (SIDS), it is not recommended to advise prone positioning for GERD during sleep [11], while the left lateral position appear a suitable alternative for the postural management of infant GERD. The therapy of pediatric GERD is based on a combination of conservative measures (i.e., lifestyle and dietary modifications), pharmacological and, rarely, surgical treatment.

  • Lastly, acid suppression itself is a recognized risk factor for community-acquired pneumonia, gastroenteritis, candidemia and necrotizing enterocolitis in preterm infants [71,72,73,74,75,76].
  • The typical adult symptoms (eg, heartburn, vomiting, regurgitation) cannot be readily assessed in infants and children.
  • If non-pharmacological approaches fail, in the opinion of the authors, patients should be investigated by pH-impedance monitoring rather than be treated “ex iuvantibus”.

The child or teen will wear a monitor for the next 24 hours. He or she will return to the hospital or outpatient center to have the tube removed.

Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your child’s esophagus. A doctor or nurse places a thin flexible tube through your child’s nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes back up into the esophagus.

This test allows the pediatric gastroenterologist to examine the lining of the esophagus, stomach and duodenum (first part of small bowel) using a camera in a flexible tube called an endoscope. He or she will look for mucosal damage from GER or other causes leading to similar symptoms. Researchers aren’t sure whether decreasing stomach acid lessens reflux in infants. Children and adults who do not improve with medical treatment may require surgical intervention.

Outcome of laparoscopic Nissen-Rossetti fundoplication in children with gastroesophageal reflux disease and supraesophageal symptoms. 29. Meining A, Classen M. The role of diet and lifestyle measures in the pathogenesis and treatment of gastroesophageal reflux disease. 2. Trudgill N. Familial factors in the etiology of gastroesophageal reflux disease, Barrett’s esophagus, and esophageal adenocarcinoma.

The placement of the tube is sometimes done while a child is sedated after an upper endoscopy, but can be done while a child is fully awake. The upper GI series can’t show mild irritation in the esophagus. It can find problems related to GERD, such as esophageal strictures, or problems with the anatomy that may cause symptoms of GERD. Up to 25 percent of children and teens have symptoms of GERD, although GERD is more common in adults. You can expect your child to stay in the hospital for about 2 to 5 days.

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