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Título

Clinical and Surgical Management of Gastroesophageal Reflux Disease (GERD) in Childrens. Literature Review

Resumo

Background: gastro-oesophageal reflux disease (GERD)
are common in infants and children and the management can be difficult.
Aims: A literature review on GERD in infants and children to outline the approach to diagnosis and management, clinical and surgical, of GERD.
Methods: A literature search in PubMed was conducted with regard to the prevalence, clinical features, diagnosis and management of GERD in children. Articles in English published during the last 10 years, the full text of which was available, were considered and the relevant information extracted.
Results: Almost 50% of all healthy infants regurgitate at least once a day which peaks at 4 months of age and subsides by 12 months in 90% of cases. Conversely, the prevalence of GERD increases with age and, by adolescence, is similar to that in adults (20%). While GERD in infancy does not require investigation or therapy, an empirical proton pump inhibitor (PPI) for 4-8 weeks is justified in older children with classical symptoms of GERD. There is no goldstandard investigation for GERD, but in extra-oesophageal manifestations, a pH/impedance is useful and endoscopy in cases with oesophagitis. PPIs play a pivotal role in the management of GERD but have not been found useful in infants with GERD. Anti-reflux surgery plays a minor role in GERD owing to the associated morbidity and high failure rate, especially in high-risk groups who most need it.
Conclusions: Unless there are warning features such as failure to thrive, haematemesis, abnormal posturing, choking/gagging or coughing while feeding, regurgitation in infancy need not be investigated. In older children and adolescents with typical reflux symptoms, empirical PPI therapy is justified. For extra-oesophageal manifestations, a pH/impedance study and endoscopy to detect oesophagitis are the investigations of choice. PPI is the mainstay of therapy in GERD, but not in GER. Surgical treament is a last option for management of GERD in children, reserve for failure of use of PPI.