✓ Gastroesophageal reflux in the child

What is gastroesophageal reflux

Gastroesophageal reflux refers to the passage of gastric material from the stomach to the esophagus, which manifests itself with regurgitation and, more rarely, also with vomiting. Reflux can be physiological or it can identify a real disease called reflux disease.

Physiological reflux usually resolves on its own by 12-18 months of life

Physiological reflux affects up to 70% of infants in the fourth month of life and is due to liquid feeding and the immaturity of the cardia, the valve located between the esophagus and stomach that should prevent food from rising. "Reflux does not disturb these children, who feed and grow well" says prof. Arrigo Barabino, head of pediatric gastroenterology at the Gaslini Hospital in Genoa; “Generally it resolves itself within the 12th-18th month, with the introduction of solid foods and with the maturation of the cardia”.

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A minority of children may continue to experience regurgitation beyond 12-18 months, developing reflux disease

In this case the esophagus wall, in contact with gastric acids, can become inflamed causing burning and pain especially during swallowing, causing the child to refuse food and consequently causing a decrease in growth. The child may also complain of pain and burning in the pit of the stomach or behind the breastbone, a feeling of acid in the mouth, up to regurgitation or vomiting of blood, which can lead to iron deficiency anemia in the long run.

The causes of reflux after 12 months: poorly toned cardia, poor motility of the esophagus, but also obesity and stress

Various factors can cause reflux after one year of age: a non-maturation of the cardia, which is poorly toned and is released when it shouldn't, a defect in the motility of the esophagus or a

stomach emptying delay; but obesity can also affect, due to the increase in gastric pressure, due to the fat of the abdominal wall, as well as stress, due to the close connections between the brain and intestine that can interfere with the motility of the digestive tract.

In much rarer cases, malformations of the upper digestive tract may be at the root of the problem.

IN THE FORUM OF mymodernparents.com MOMS TALK ABOUT REFLUSSO

Physiological reflux does not require treatment, reflux disease is treated with specific drugs

The physiological reflux that appears before the age of one does not require therapy: if the baby is bottle-fed, AR (anti-regurgitation) milks, thickened with starch or carob flour, can help.

For reflux disease, the approach varies according to age: in young children, who are unable to report their symptoms, it may be necessary to carry out specialist investigations for diagnostic confirmation.

After about 6 years, however, the diagnosis can only be formulated on a clinical basis and in this case one tries to administer, for a two-week course, specific anti-reflux drugs, i.e. the so-called inhibitors of

proton pump (the English abbreviation is PPI), which block the production of stomach acid: if there is an improvement, the treatment is continued for a couple of months.

In most cases, the problem resolves itself after complete therapy; "If, on the other hand, there is no improvement or a relapse occurs after a complete course of therapy, it is necessary to resort to specialist investigations, such as an esophagus-stomach-duodenum x-ray (to exclude malformations at the base of reflux) and a pH or pH impedance measurement, that is an exam that in 24 hours records the refluxes with a nasogastric tube connected to a small laptop ”says prof. Barabino. In this case, the specialist will decide how to proceed.

For older children: no carbonated drinks, chocolate and mint. No citrus and tomatoes

Some dietary advice can be used to prevent reflux or relieve a little the sense of burning, it being understood that if the mucous membrane of the esophagus is particularly irritated, drug treatment is inevitable: for example, it is good to avoid carbonated drinks, which dilate the stomach. , as well as chocolate and mint, which can act on the pressure of the sphincter; also no to acidic foods, such as citrus fruits and tomatoes, which cause burning of the already irritated mucosa and can make the disorder worse.

“Once the inflammation has resolved, however, the child can safely go back to eating everything” concludes the gastroenterologist.

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