15RudolphChildGERD.pdf

New Guidelines for Management of Childhood GERD Colin Rudolph, MD, PhD Professor of Pediatrics NASPGHAN-ESPGHAN JOINT GERD GUIDELINE COMMITTEE Symptoms and Signs of GERD INFANT ? Recurrent regurgitation ? Failure to gain weight? ? Esophagitis ? Feeding refusal ? ? Irritability ? ? Hematemasis ? Apnea or ALTE ? ? Wheezing ? ? Recurrent pneumonia ? Upper airway symptoms CHILD / ADOLESCENT ? Recurrent regurgitation ? Esophagitis ? Hematemesis ? Heartburn ? Abdominal pain ? Dysphagia ? Asthma ? ? Recurrent pneumonia ? Upper airway symptoms? Pathogenic Factors in Esophagitis Mechanisms of GER ? Transient LES relaxation ? Intra-abdominal pressure ? Reduced esophageal capacitance ? Gastric compliance ? Delayed gastric emptying Mechanisms of Esophageal Complications ? Impaired esophageal clearance ? Defective tissue resistance ? Noxious composition of refluxate Mechanisms of Airway Complications ? Vagal reflexes ? Impaired airway protection Esophagus LES Crural diaphragm Pylorus Stomach Angle of His Pharynx UES Esophageal Acid Clearance Acid bolus Total 3H pH mmHg Acid bolus Dental sucker Esophagitis symptoms in childhood Esophageal ? Pain ? Regurgitation ? Dysphagia ? Hematemesis ? Anemia GER Esophagitis GER Esophagitis with ulcer ENDOSCOPY 0 2 4 6 8 10 12 14 16 18 20 Prevalence of GERD Symptoms in Children Nelson et al, Arch Pediatr Adolesc Med 2000;154:150 and Locke et al, Gastroenterology 1997;112:1448 % of Children Heartburn Epigastric pain Regurgitation Heartburn and/or acid regurgitation 566 parents of children aged 3-9 yr 615 children aged 10-17 yr 2200 adults aged 25-74 years Can an accurate diagnosis of GERD be based upon symptoms in children? ? Children tend to answer questions in the affirmative making history less reliable ? Are you having pain? Yes ? The ability to describe and localize pain is highly variable among children ? Is the pain in your chest? Yes ? Does the pain feel like burning? Yes ? GERD symptom reports in young children have no