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Pediatric Reflux

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Pediatric Reflux

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    1. Pediatric Reflux Frederick S. Rosen, MD Norman R. Friedman, MD October 25, 2000

    2. Pediatric Reflux Functional Gastroesophageal Reflux GERD Secondary Gastroesophageal Reflux

    3. Lower Esophageal Sphincter Pinch-Cock Action Intraabdominal Esophagus Angle of His Mucosal Rosette High Pressure Zone Abdominal Pressure

    4. Reflux events in infants Maturation of LES at 5-7 weeks of life, regardless of gestational age Esophagitis and TLESRs – a vicious Cycle Acid & Pepsin, Bile Acids and Trypsin

    5. Typical presentation of GERD Crying/Irritability Poor feeding Regurgitation Epigastric pain FTT/weight loss Sore throat Waterbrash Hematemesis Anemia

    6. Atypical presentation of GERD Apnea/Bradycardia ALTEs Wheezing/Asthma Stridor Recurrent pneumonia Chronic cough Sandifer’s syndrome Hoarseness/ Laryngitis Otalgia Sinusitis

    7. GERD Untreated Resolves by 2 years of age in 60% of GERD Persists until age 4 in 30% ˝ stricture, ˝ malnutrition

    8. GERD in Otolaryngology Chronic Sinusitis – avoid FESS Chronic Cough Globus Pharyngeus- osteophytes, FB, cricopharyngeus, tonsils, goiter, web, cervical lad, mass Dysphagia

    9. GERD in Otolaryngology Otitis Media?

    10. GERD in Otolaryngology Vocal cord granuloma Laryngomalacia Pseudolaryngomalacia Subglottic stenosis Sandifer’s Synd.

    11. Apnea & ALTEs 7-15% SIDS At least 53% of ALTEs Esophagolaryngeal Adductor Reflex – obstructive apnea Laryngeal Chemoreflex – Central Apnea Seizure and Reflux?

    12. Asthma Vicious Cycle Macroaspiration Microaspiration Esophagitis – vagal reflex <3 yo do better Fundoplication improves 88%

    13. Differential diagnosis Food allergy (cow milk) Infection Increased intracranial pressure (tumor) Hydronephrosis Intestinal obstruction Metabolic Disorders (uremia)

    14. Diagnosing GERD

    15. Diagnosing GERD Upper GI Esophageal biopsy DL and Bronch pH probe Scintigraphy Modified Bernstein Test Manometry

    16. Diagnosing GERD

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