Advertisement

Symptoms

  • Paolo Quitadamo
  • Annamaria Staiano
Chapter

Abstract

Gastroesophageal reflux (GER) is defined as the passage of gastric contents into the esophagus. GER is a normal physiologic process occurring several times per day in healthy infants, children, and adults. Most episodes of GER in healthy individuals last <3 min, occur in the postprandial period, and cause few or no symptoms. Conversely, gastroesophageal reflux disease (GERD) is present when the reflux of gastric contents into the esophagus causes troublesome symptoms and/or complications. Distinguishing physiologic GER from GERD may often be tricky, especially in infants. Indeed, in the first months of life, GER usually underlies recurrent regurgitation and vomiting, mainly due to anatomic features and liquid feeding. These symptoms, along with persisting crying and irritability, are often a source of anxiety for parents. Clinicians should be aware that the vast majority of these spitting infants does not deserve diagnostic test, and GERD should be suspected only when alarm signs arise.

Unlike infants, children and adolescents do not usually experience any relevant symptom related to physiologic GER. Therefore, in these age groups symptoms such as vomiting, heartburn, and chest pain should not be overlooked, and a diagnostic work-up is advisable. Only in older children and adolescents, an empiric acid-suppressive trial may be recommended. Respiratory symptoms, such as cough, wheezing, and hoarseness, may also be associated with GERD, being sometimes the only “atypical” presentation of the disease.

Keywords

Gastroesophageal reflux Gastroesophageal reflux disease Regurgitation Vomiting Irritability Heartburn Chest pain Typical GERD presentation Atypical GERD presentation Respiratory symptoms 

References

  1. 1.
    Sherman P, Hassall E, Fagundes-Neto U, et al. A global evidence-based consensus on the definition of gastroesophageal reflux disease in children. Am J Gastroenterol. 2009;104:1278–95.CrossRefPubMedGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    Hegar B, Dewanti NR, Kadim M, et al. Natural evolution of regurgitation in healthy infants. Acta Paediatr. 2009;98:1189–93.CrossRefPubMedGoogle Scholar
  4. 4.
    Orenstein SR. Curr Gastroenterol Rep. 2013;15:353.CrossRefPubMedGoogle Scholar
  5. 5.
    Moore DJ, Tao BS, Lines DR, et al. Double-blind placebo-controlled trial of omeprazole in irritable infants with gastroesophageal reflux. J Pediatr. 2003;143:219–37.CrossRefPubMedGoogle Scholar
  6. 6.
    Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900–20.CrossRefPubMedGoogle Scholar
  7. 7.
    Singh S, Richter JE, Bradley LA, et al. The symptom index. Differential usefulness in suspected acid-related complaints of heartburn and chest pain. Dig Dis Sci. 1993;38:1402–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Richter JE. A critical review of current medical therapy for gastroesophageal reflux disease. J Clin Gastroenterol. 1986;8(Suppl 1):S72–80.CrossRefGoogle Scholar
  9. 9.
    Vakil N. Proton pump inhibitors for dyspepsia. Dig Dis. 2008;26:215–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Feranchak AP, Orenstein SR, Cohn JF. Behaviors associated with onset of gastroesophageal reflux episodes in infants. Prospective study using split-screen video and pH probe. Clin Pediatr (Philadelphia). 1994;33:654–62.CrossRefGoogle Scholar
  11. 11.
    Heine RG, Jordan B, Lubitz L, et al. Clinical predictors of pathological gastro-oesophageal reflux in infants with persistent distress. J Paediatr Child Health. 2006;42:134–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Vandenplas Y, Badriul H, Verghote M, et al. Oesophageal pH monitoring and reflux oesophagitis in irritable infants. Eur J Pediatr. 2004;163:300–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Heine RG, Cameron DJ, Chow CW, et al. Esophagitis in distressed infants: poor diagnostic agreement between esophageal pH monitoring and histopathologic findings. J Pediatr. 2002;140:14–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Heine RG, Jaquiery A, Lubitz L, et al. Role of gastro-oesophageal reflux in infant irritability. Arch Dis Child. 1995;73:121–5.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Chadwick LM, Kurinczuk JJ, Hallam LA, et al. Clinical and endoscopic predictors of histological oesophagitis in infants. J Paediatr Child Health. 1997;33:388–93.CrossRefPubMedGoogle Scholar
  16. 16.
    von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain. 2007;127:140–50.CrossRefGoogle Scholar
  17. 17.
    Kleinman L, Rothman M, Strauss R, et al. The infant gastroesophageal reflux questionnaire revised: development and validation as an evaluative instrument. Clin Gastroenterol Hepatol. 2006;4:588–96.CrossRefPubMedGoogle Scholar
  18. 18.
    Aggarwal S, Mittal SK, Kalra KK, et al. Infant gastroesophageal reflux disease score: reproducibility and validity in a developing country. Trop Gastroenterol. 2004;25:96–8.PubMedGoogle Scholar
  19. 19.
    Salvatore S, Hauser B, Vandemaele K, et al. Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology? J Pediatr Gastroenterol Nutr. 2005;40:210–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Orenstein SR, Hassall E, Furmaga-Jablonska W, et al. Multicenter, double-blind, randomized, placebo-controlled trial assessing efficacy & safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. J Pediatr. 2009;154:514–20.CrossRefPubMedGoogle Scholar
  21. 21.
    Tolia V, Vandenplas Y. Systematic review: the extra-oesophageal symptoms of gastro-oesophageal reflux disease in children. Aliment Pharmacol Ther. 2009;29:258–72.CrossRefPubMedGoogle Scholar
  22. 22.
    Stordal K, Johannesdottir GB, Bentsen BS, et al. Gastroesophageal reflux disease in children: association between symptoms and pH monitoring. Scand J Gastroenterol. 2005;40:636–40.CrossRefPubMedGoogle Scholar
  23. 23.
    Deal L, Gold BD, Gremse DA, et al. Age-specific questionnaires distinguish GERD symptom frequency and severity in infants and young children: development and initial validation. J Pediatr Gastroenterol Nutr. 2005;41:178–85.CrossRefPubMedGoogle Scholar
  24. 24.
    Tolia V, Bishop PR, Tsou VM, et al. Multicenter, randomized, double-blind study comparing 10, 20 and 40mg pantoprazole in children (5–11 years) with symptomatic gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2006;42:384–91.CrossRefPubMedGoogle Scholar
  25. 25.
    Stanford EA, Chambers CT, Craig KD. The role of developmental factors in predicting young children’s use of a self-report scale for pain. Pain. 2006;120:16–23.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Stanford EA, Chambers CT, Craig KD. A normative analysis of the development of pain-related vocabulary in children. Pain. 2005;114:278–84.CrossRefPubMedGoogle Scholar
  27. 27.
    Beyer JE, McGrath PJ, Berde CB. Discordance between selfreport and behavioral pain measures in children aged 3–7 years after surgery. J Pain Symptom Manag. 1990;5:350–6.CrossRefGoogle Scholar
  28. 28.
    Shields BJ, Palermo TM, Powers JD, et al. Predictors of a child’s ability to use a visual analogue scale. Child Care Health Dev. 2003;29:281–90.CrossRefPubMedGoogle Scholar
  29. 29.
    Shi G, Bruley des Varannes S, Scarpignato C, et al. Reflux related symptoms in patients with normal oesophageal exposure to acid. Gut. 1995;37:457–64.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Vakil N. Review article: the role of surgery in gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2007;25:1365–72.CrossRefPubMedGoogle Scholar
  31. 31.
    Dent J, Brun J, Fendrick AM, et al. An evidence-based appraisal of reflux disease management—the Genval workshop report. Gut. 1999;44(Suppl 2):S1–6.CrossRefPubMedCentralGoogle Scholar
  32. 32.
    Chirila I, Morariu ID, Barboi OB, Drug VL. The role of diet in the overlap between gastroesophageal reflux disease and functional dyspepsia. Turk J Gastroenterol. 2016;27(1):73–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Lee SW, Lee TY, Lien HC, Yeh HZ, Chang CS, Ko CW. The risk factors and quality of life in patients with overlapping functional dyspepsia or peptic ulcer disease with gastroesophageal reflux disease. Gut Liver. 2014;8(2):160–4.CrossRefPubMedGoogle Scholar
  34. 34.
    Rasquin-Weber A, Hyman PE, Cucchiara S, Fleisher DR, Hyams JS, Milla PJ, et al. Childhood functional gastrointestinal disorders. Gut. 1999;45:II60–8.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Tack J, Piessevaux H, Coulie B, Caenepeel P, Janssens J. Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology. 1998;115:1346–52.CrossRefPubMedGoogle Scholar
  36. 36.
    Peter CS, Sprodowski N, Bohnhorst B, et al. Gastroesophageal reflux and apnea of prematurity: no temporal relationship. Pediatrics. 2002;109:8–11.CrossRefPubMedGoogle Scholar
  37. 37.
    Wenzl TG, Schenke S, Peschgens T, et al. Association of apnea and nonacid gastroesophageal reflux in infants: investigations with the intraluminal impedance technique. Pediatr Pulmonol. 2001;31:144–9.CrossRefPubMedGoogle Scholar
  38. 38.
    Mousa H, Woodley FW, Metheney M, et al. Testing the association between gastroesophageal reflux and apnea in infants. J Pediatr Gastroenterol Nutr. 2005;41:169–77.CrossRefPubMedGoogle Scholar
  39. 39.
    Menon AP, Schefft GL, Thach BT. Apnea associated with regurgitation in infants. J Pediatr. 1985;106:625–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Cote A, Hum C, Brouillette RT, et al. Frequency and timing of recurrent events in infants using home cardiorespiratory monitors. J Pediatr. 1998;132:783–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Kahn A, Rebuffat E, Sottiaux M, et al. Lack of temporal relation between acid reflux in the proximal oesophagus and cardiorespiratory events in sleeping infants. Eur J Pediatr. 1992;151:208–12.CrossRefPubMedGoogle Scholar
  42. 42.
    Sahewalla R, Gupta D, Kamat D. Apparent life-threatening events: an overview. Clin Pediatr (Philadelphia). 2015;55:5–9.CrossRefGoogle Scholar
  43. 43.
    Branski RC, Bhattacharyya N, Shapiro J. The reliability of the assessment of endoscopic laryngeal findings associated with laryngopharyngeal reflux disease. Laryngoscope. 2002;112:1019–24.CrossRefPubMedGoogle Scholar
  44. 44.
    McMurray JS, Gerber M, Stern Y, et al. Role of laryngoscopy, dual pH probe monitoring, and laryngeal mucosal biopsy in the diagnosis of pharyngoesophageal reflux. Ann Otol Rhinol Laryngol. 2001;110:299–304.CrossRefPubMedGoogle Scholar
  45. 45.
    Yellon RF, Coticchia J, Dixit S. Esophageal biopsy for the diagnosis of gastroesophageal reflux-associated otolaryngologic problems in children. Am J Med. 2000;108:131S–8S.CrossRefPubMedGoogle Scholar
  46. 46.
    Halstead LA. Gastroesophageal reflux: a critical factor in pediatric subglottic stenosis. Otolaryngol Head Neck Surg. 1999;120:683–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Ours TM, Kavuru MS, Schilz RJ, et al. A prospective evaluation of esophageal testing and a double-blind, randomized study of omeprazole in a diagnostic and therapeutic algorithm for chronic cough. Am J Gastroenterol. 1999;94:3131–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Fortunato JE, Troy AL, Cuffari C, et al. Outcome after percutaneous endoscopic gastrostomy in children and young adults. J Pediatr Gastroenterol Nutr. 2010;50:390–3.PubMedGoogle Scholar
  49. 49.
    Field SK. A critical review of the studies of the effects of simulated or real gastroesophageal reflux on pulmonary function in asthmatic adults. Chest. 1999;115:848–56.CrossRefPubMedGoogle Scholar
  50. 50.
    Herve P, Denjean A, Jian R, et al. Intraesophageal perfusion of acid increases the bronchomotor response to methacholine and to isocapnic hyperventilation in asthmatic subjects. Am Rev Respir Dis. 1986;134:986–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Translational Medical Science, Section of Pediatrics, “Federico II”University of NaplesNaplesItaly
  2. 2.Department of PediatricsAORN Santobono-PausiliponNaplesItaly

Personalised recommendations