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Reflux in Children

  • General Surgery (D Carney, Section Editor)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Opinion statement

Physiologic reflux is a common condition in healthy newborns. Most of the symptoms of physiologic reflux disappear by age one; however, in those children where symptoms persist, consequences can be severe leading to gastroesophageal reflux disease (GERD). Various physiological as well as anatomical factors can contribute to the pathophysiology of this disease. Children with GERD may present with symptoms ranging from heartburn, emesis, regurgitation, and irritability to more complex problems such as esophageal strictures or esophageal metaplasia. GERD can also lead to significant asthma, chronic cough, hoarseness, and repeated pneumonias. It is imperative to perform a thorough evaluation in order to properly identify GERD, but diagnostic confirmation can be challenging. There is little consensus and limited evidence to support a single diagnostic test or standard work-up for the evaluation of GERD in children. Hence, a combination of history and physical along with multiple, complimentary diagnostic tests is often required to accurately diagnose GERD. Most children with GERD will do well with medical management alone. Minimally invasive surgery is the standard of care and should be performed in infants and children who fail maximal medical management or sustain severe complications from GERD.

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References and Recommended Reading

  1. Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric practice research group. Arch Pediatr Adolesc Med. 2000;154(2):150–4.

  2. Liebermann-Meffert D, Allgower M, Schmid P, Blum AL. Muscular equivalent of the lower esophageal sphincter. Gastroenterology. 1979;76(1):31–8.

    CAS  PubMed  Google Scholar 

  3. Thor KB, Hill LD, Mercer DD, Kozarek RD. Reappraisal of the flap valve mechanism in the gastroesophageal junction. A study of a new valvuloplasty procedure in cadavers. Acta Chir Scand. 1987;153(1):25–8.

    CAS  PubMed  Google Scholar 

  4. Capito C, Leclair MD, Piloquet H, Plattner V, Heloury Y, Podevin G. Long-term outcome of laparoscopic Nissen-Rossetti fundoplication for neurologically impaired and normal children. Surg Endosc. 2008;22(4):875–80.

    Article  CAS  PubMed  Google Scholar 

  5. Barron JJ, Tan H, Spalding J, Bakst AW, Singer J. Proton pump inhibitor utilization patterns in infants. J Pediatr Gastroenterol Nutr. 2007;45(4):421–7.

    Article  CAS  PubMed  Google Scholar 

  6. Vandenplas Y, Goyvaerts H, Helven R, Sacre L. Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics. 1991;88(4):834–40.

    CAS  PubMed  Google Scholar 

  7. Acher CW, Ostlie DJ, Leys CM, Struckmeyer S, Parker M, Nichol PF. Long-term outcomes of patients with tracheoesophageal fistula/esophageal atresia: survey results from tracheoesophageal fistula/esophageal atresia online communities. Eur J Pediatr Surg. 2016;26(6):476–80.

    PubMed  Google Scholar 

  8. Esposito C, Langer JC, Schaarschmidt K, et al. Laparoscopic antireflux procedures in the management of gastroesophageal reflux following esophageal atresia repair. J Pediatr Gastroenterol Nutr. 2005;40(3):349–51.

    Article  PubMed  Google Scholar 

  9. Beaudoin S, Kieffer G, Sapin E, Bargy F, Helardot PG. Gastroesophageal reflux in neonates with congenital abdominal wall defect. Eur J Pediatr Surg. 1995;5(6):323–6.

    Article  CAS  PubMed  Google Scholar 

  10. Borrelli O, Marabotto C, Mancini V, et al. Role of gastroesophageal reflux in children with unexplained chronic cough. J Pediatr Gastroenterol Nutr. 2011;53(3):287–92.

    Article  PubMed  Google Scholar 

  11. Brand DA, Altman RL, Purtill K, Edwards KS. Yield of diagnostic testing in infants who have had an apparent life-threatening event. Pediatrics. 2005;115(4):885–93.

    Article  PubMed  Google Scholar 

  12. Semeniuk J, Kaczmarski M, Wasilewska J, Nowowiejska B. Is acid gastroesophageal reflux in children with ALTE etiopathogenetic factor of life threatening symptoms. Adv Med Sci. 2007;52:213–21.

    CAS  PubMed  Google Scholar 

  13. Lee WS, Beattie RM, Meadows N, Walker-Smith JA. Gastro-oesophageal reflux: clinical profiles and outcome. J Paediatr Child Health. 1999;35(6):568–71.

    Article  CAS  PubMed  Google Scholar 

  14. Field SK. Underlying mechanisms of respiratory symptoms with esophageal acid when there is no evidence of airway response. Am J Med. 2001;111(Suppl 8A):37S–40S.

    Article  PubMed  Google Scholar 

  15. Moser G, Vacariu-Granser GV, Schneider C, et al. High incidence of esophageal motor disorders in consecutive patients with globus sensation. Gastroenterology. 1991;101(6):1512–21.

    Article  CAS  PubMed  Google Scholar 

  16. Canning BJ, Mazzone SB. Reflex mechanisms in gastroesophageal reflux disease and asthma. Am J Med. 2003;115(Suppl 3A):45S–8S.

    Article  PubMed  Google Scholar 

  17. Valusek PA, St Peter SD, Keckler SJ, et al. Does an upper gastrointestinal study change operative management for gastroesophageal reflux? J Pediatr Surg. 2010;45(6):1169–72.

    Article  PubMed  Google Scholar 

  18. Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49(4):498–547.

    Article  PubMed  Google Scholar 

  19. Boyle JT. Gastroesophageal reflux disease in 2006. The imperfect diagnosis. Pediatr Radiol. 2006;36(Suppl 2):192–5.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rosen R, Fritz J, Nurko A, Simon D, Nurko S. Lipid-laden macrophage index is not an indicator of gastroesophageal reflux-related respiratory disease in children. Pediatrics. 2008;121(4):e879–84.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Salvatore S, Hauser B, Devreker T, et al. Esophageal impedance and esophagitis in children: any correlation? J Pediatr Gastroenterol Nutr. 2009;49(5):566–70.

    Article  CAS  PubMed  Google Scholar 

  22. Salvatore S, Salvatoni A, Van Berkel M, et al. Esophageal impedance baseline is age dependent. J Pediatr Gastroenterol Nutr. 2013;57(4):506–13.

    Article  PubMed  Google Scholar 

  23. Lopez-Alonso M, Moya MJ, Cabo JA, et al. Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux. Pediatrics. 2006;118(2):e299–308.

    Article  PubMed  Google Scholar 

  24. Valusek PA, St Peter SD, Tsao K, Spilde TL, Ostlie DJ, Holcomb 3rd GW. The use of fundoplication for prevention of apparent life-threatening events. J Pediatr Surg. 2007;42(6):1022–4. discussion 5

    Article  PubMed  Google Scholar 

  25. Estevao-Costa J, Fragoso AC, Prata MJ, et al. Gastric emptying and antireflux surgery. Pediatr Surg Int. 2011;27(4):367–71.

    Article  PubMed  Google Scholar 

  26. Kane TD, Brown MF, Chen MK. Members of the ANTC. Position paper on laparoscopic antireflux operations in infants and children for gastroesophageal reflux disease. American pediatric surgery association. J Pediatr Surg. 2009;44(5):1034–40.

    Article  PubMed  Google Scholar 

  27. Rothenberg SS. The first decade's experience with laparoscopic Nissen fundoplication in infants and children. J Pediatr Surg. 2005;40(1):142–6. discussion 7

    Article  PubMed  Google Scholar 

  28. Kubiak R, Andrews J, Grant HW. Laparoscopic Nissen fundoplication versus Thal fundoplication in children: comparison of short-term outcomes. J Laparoendosc Adv Surg Tech A. 2010;20(7):665–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Department of General and Thoracic Surgery, Children’s National Medical Center, 111 Michigan Ave, Washington, DC, 20010, USA

    Mikael Petrosyan MD, Alexis Sandler MD & Andrea Badillo MD

Authors
  1. Mikael Petrosyan MD
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  2. Alexis Sandler MD
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  3. Andrea Badillo MD
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Correspondence to Mikael Petrosyan MD.

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Conflict of Interest

Mikael Petrosyan declares that he has no conflict of interest. Alexis Sandler declares that she has no conflict of interest. Andrea Badillo declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on General Surgery

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Petrosyan, M., Sandler, A. & Badillo, A. Reflux in Children. Curr Treat Options Peds 3, 157–162 (2017). https://doi.org/10.1007/s40746-017-0083-y

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