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Gastroesophageal reflux GER AND Gastroesophageal reflux diseaseGERD

. GERD :most common esophageal disorder in children.GER :retrograde movement of gastric contents.Physiological reflux: regurgitation in normal infant.GERD: pathological reflux in children more frequent or persistent produce esophagitis or esophageal symptoms respiratory complications failure

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Gastroesophageal reflux GER AND Gastroesophageal reflux diseaseGERD

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    1. Gastroesophageal reflux (GER) AND Gastroesophageal reflux disease(GERD) Dr. Miral Almomani

    2. GERD :most common esophageal disorder in children. GER :retrograde movement of gastric contents. Physiological reflux: regurgitation in normal infant. GERD: pathological reflux in children more frequent or persistent produce esophagitis or esophageal symptoms respiratory complications failure to thrive

    3. other DD of chronic vomiting : - milk or other food allergies - pyloric stenosis - intestinal obstruction - infection - hydronephrosis - increased ICP

    4. Infantile reflux: - first few months - peaks at 4 month - resolves by 12-24month Presentation: - regurgitation - signs of esophagitis (irritability,arching,choking and gagging) - respiratory presentation ( obstructive apnea, stridor )

    5. Older children: - regurgitation in preschool - abdominal & chest pain - neck contortion ( arching, turning of head)= sandifer syndrome Diagnosis: - good Hx & exam - radiographic barium - 24-hour PH monitoring - endoscopy

    6. 24-hour PH monitoring: best means of assessing reflux reflux varies with activity and sleep state placed at a level of LES ( PH less than 4) Endoscopy: - dx of erosive esophagitis, strictures & barrett esophagus. - esophageal Bx - theraputic ( dilation of strictures)

    7. Management: positioning measures pharmacotherapy surgery ( fundiplication) Positioning measures:-important for infant - prone position

    8. Pharmacotherpy: antacids:- most commonly used - rapid but transient relief - acid neutralization - side effects on long-term use histamine-2receptor antagonist(H2RAs): - e.g: cimetidine,ranitidine &famotidine) - antisecretory agents=selective inhibition of H receptor - mild to moderate reflux esophagitis.

    9. Proton pump inhibitors(PPI): e.g: omperazole, lanzoprazole &esomprazole. most potent antireflux Blocking H-K ATPase superior to H2RAs in sever & erosive esophagitis. prokinetic agents:e.g: metopromide no adequate studies in children

    10. Surgery (fundiplication): intractable GERD( refractory esophagitis) Complications : wrap is “too tight “ or “too loose” Complications of GERD: esophagitis FTT respiratory presentation ( apnea, stridor) reflux laryngitis

    11. Take home messages GER is phsiological refLux while GERD is pathological reflux. GERD is associated with esophagitis & FTT Clinical presentation is age dependent. 24-hour PH monitoring is the most sensitive test PPI provide the most effective antireflux medication.

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