Ger in children treatment. Why is the baby spitting up? Causes of GER in children

Gastroesophageal (gastroesophageal) reflux refers to the return of food eaten and stomach acid back into the esophagus. Due to the immature digestive system in infants this phenomenon occurs constantly and does not pose a danger to the health of the baby. The state reaches its peak at the age of 4 months, gradually fading away by the 6-7th month from birth and completely disappearing by 1-1.5 years.

In a newborn child, the esophagus is anatomically short, and the valve that blocks the passage of food back from the stomach is poorly developed. It leads to frequent regurgitation milk or adapted formula, depending on the type of feeding.

According to the predominant contents thrown into the esophagus, refluxes are distinguished:

Alkaline, in which substances are thrown from the stomach and intestines with an admixture of bile and lysolecithin, the acidity in this case exceeds 7%.
Acidic - contributes to the entry of hydrochloric acid into the esophagus, lowering its acidity to 4%.
Low acid - leads to acidity from 4 to 7%.

Symptoms of gastroesophageal reflux

In addition to heartburn and regurgitation, reflux in a child is often disguised as symptoms of diseases of other organs and systems:

Digestive disorders: vomiting, pain in the upper part of the stomach, constipation.
Inflammation of the respiratory system. The reflux of gastric contents is sometimes not limited to the esophagus and passes further into the pharynx, getting from there into the respiratory tract. It causes:

Cough, mainly at night, sore throat, hoarse crying in infants.
Otitis (inflammation of the ear).
Chronic pneumonia, non-infectious bronchial asthma.

Diseases of the teeth. This is caused by the fact that acidic gastric juice corrodes tooth enamel, leading to rapid development caries and tooth decay.
Violations by of cardio-vascular system: arrhythmia, pain behind the sternum in the region of the heart.

Treatment of gastroesophageal reflux

An uncomplicated type of condition does not need medication, it is enough to adjust the diet and feeding habits of the child.

Feed your baby more often, but in smaller portions.
In case of allergies, exclude cow's milk proteins from the diet of newborns and nursing mothers. Use for feeding special mixtures that do not contain milk proteins, such as Frisopep, Nutrilon Pepti. The effect is more often achieved after three weeks of following this diet.
Add thickeners to the diet or use ready-made anti-reflux mixtures. They contain substances that inhibit the reverse flow of food into the esophagus. This type of food includes locust bean gum or starch (potato, corn). Mixtures where gum acts as a thickener - Nutrilak, Humana Antireflux, Frisovoy, Nutrilon; the thickener starch is present in baby food brands NAN and Samper Lemolak. If the baby is breastfed, a thickener is added to the expressed milk, which can be bought at a pharmacy. Children older than 2 months are allowed to give a teaspoon before feeding rice porridge without milk, which contributes to the thickening of the food eaten.
After feeding, ensure that the baby stays in vertical position at least 20 minutes. For infants, wearing a column immediately after eating is suitable.

In the absence of the effect of such measures, the use of drugs will be required.

Antacids (Maalox, Phosphalugel), enzymes (Protonix) are used to neutralize gastric acid and reduce its harm to the esophageal mucosa.
To speed up digestion and strengthen the esophageal sphincter, drugs Raglan, Propulsid have been developed.
The elimination of manifestations of heartburn in an infant is facilitated by the intake of alginates.
A decrease in the production of stomach acid is caused by proton pump inhibitors (omeprazole).
Histamine H-2 blockers (Pepsid, Zantak).

If such treatment has not brought noticeable improvements and the condition is aggravated by the presence of diverticula or hernias of the esophagus, there will be a need for surgical intervention. This operation is called fundoplication and consists in the formation of a new gastroesophageal sphincter. The esophagus is lengthened and connected to the entrance to the stomach by a special muscular ring. The procedure allows you to nullify attacks of pathological reflux.

Determine expediency surgical operation help following methods diagnostics:

X-ray with barium allows you to analyze the work of the upper section digestive system.
24-hour pH monitoring involves placing a thin tube into the esophagus to test for acidity and the severity of regurgitation.
Endoscopy of the esophagus and stomach allows you to determine the presence of ulcers, erosion, swelling of the mucous membrane of organs.

Sphincteromanometry provides data on the functioning of the organ that connects the esophagus to the stomach. The degree of sphincter closure after a meal is studied, which is directly related to episodes of reflux.
An isotope study allows you to determine the movement of food through the upper part of the digestive system in a child.

If complicated gastrointestinal esophageal reflux begins to progress, there is a risk of complications in the form of gastroesophageal reflux disease. There are also more serious, and even life threatening consequences of this disease, such as:

inability to eat due to pain and discomfort, which will lead to weight loss and beriberi;
erosive damage to the esophagus, its pathological narrowing, esophagitis (inflammation);
food entering the respiratory tract, which can cause suffocation;
bleeding and perforation of the organ;
degeneration of the cells of the esophageal mucosa, which creates prerequisites for oncological diseases.

In most cases, gastroesophageal reflux in a child under one year old does not cause concern to doctors, and there is no need to treat it, since it disappears without a trace with age. If the condition continues to recur in children older than one and a half years, even with a decrease in the number of episodes, it is advisable to consult a doctor with a subsequent examination.

In recent years, the attention of pediatric gastroenterologists and pediatric surgeons to diseases of the esophagus has increased significantly. This is due to the fact that the pathological reflux of the contents of the stomach into the lumen of the esophagus leads to serious changes in the mucous membrane of the esophagus, worsens the course of respiratory diseases and significantly changes the quality of life of the child.
In the group of diseases of the esophagus, the most common gastroesophageal reflux disease (GERD). The name of the pathology comes from the words gaster- stomach , oesophagus- esophagus and refluxus- reverse flow. The basis of the disease is the development of characteristic signs of reflux of gastric contents (less often, the contents of the duodenum) into the lumen of the esophagus and the development of an inflammatory lesion of the lower esophagus (reflux esophagitis). The section “Diseases of the digestive system in children/Esophagus” provides data on the anatomical structure of the esophagus, which help to understand the mechanism of development of gastroesophageal reflux. Reflux may occur due to relaxation or a decrease in pressure in the lower esophageal sphincter (obturator muscle); disorders of gastric emptying; increase in intra-abdominal pressure.

Regurgitation is the passive reflux of a small amount of gastric contents into the pharynx and oral cavity. This is a manifestation of gastroesophageal reflux (GER) without signs of esophagitis. GER usual physiological phenomenon in children the first three months of life and is often accompanied by habitual regurgitation or vomiting. In addition to underdevelopment lower section esophagus, reflux in newborns is based on such reasons as a small volume of the stomach and its spherical shape, slow emptying. Basically physiological reflux has no clinical implications and resolves spontaneously when an effective antireflux barrier is gradually established with the introduction of solid food - by 12-18 months after birth.

The basis of the primary failure of the antireflux mechanisms in young children, as a rule, is a violation of the regulation of the activity of the esophagus from the autonomic nervous system. Autonomic dysfunction, most often, is due to cerebral hypoxia, which develops during unfavorable pregnancies and childbirth. The relationship between birth injuries of the spine and spinal cord, more often in cervical region, and functional disorders of the digestive tract.
Very often, young children “choke” on breast milk and then spit up if the mother has a large amount of milk and it easily expires from the mammary gland (galactorrhea). In this case, you should try to ensure that the child tightly covers the nipple and does not swallow air.
In the event that regurgitation is very persistent and the child does not have pyloric stenosis (see section "Diseases of the newborn"), an additional examination is necessary to rule out gastroesophageal reflux disease. An ultrasound is performed and, according to indications, fibroesophagogastroscopy. All patients with regurgitation should be consulted by a pediatric neurologist.

GERD may be suspected when GER presents with regurgitation and vomiting that does not respond to trial treatment with thick formulas and medications. Clinical symptoms that should alert parents and the doctor are vomiting with blood, delayed physical and mental development of the child, constant unmotivated crying, coughing, and sleep disturbance.
Rarely seen in children rumination syndrome(“chewing gum”). In this condition, gastric contents are thrown into the oral cavity and swallowed again. Noted that being alone. Children may choke on their own tongue or fingers. As a rule, this syndrome is observed in children from 2 to 12 months, but can occur in children of schoolchildren. The tense situation in the family contributes to the manifestations of rumination, so this condition is regarded as a manifestation of increased nervousness and anxiety in the child.

Treatment regurgitation in children is divided into several successive stages. A number of authors recommend frequent feedings in small portions. At the same time, feeding in small amounts leads to an increase in the number of feedings and, accordingly, to an increase in the number of "afternoon" gaps, which increases the number of regurgitation after meals and increases parental anxiety. In real practice, this measure is very difficult to apply, since frequent feedings limit the activity of parents; also, reducing the volume of feeding can be stressful for the baby when he is hungry and does not want to stop suckling. The effectiveness of this recommendation has not been proven. However, the volume of feeding must be reduced, and ultimately the frequency of feeding must be adjusted to avoid overfeeding the babies.

Of particular importance at an early age is the so-called postural therapy. It is aimed at reducing the degree of reflux and helps to cleanse the esophagus from gastric contents and reduces the risk of developing esophagitis and aspiration pneumonia. Feeding the baby infancy it is desirable to carry out in a position at an angle of 45-60 degrees. Since there is no peristalsis of the esophagus during sleep at night, it is necessary that the child sleeps with the head end of the crib raised in the side position.

Recommendations dietary correction regurgitation with mixed and artificial feeding based on an analysis of the ratio: casein/whey proteins in the prescribed mixture. Based on the fact that the formula for the child should be as close as possible to human milk in composition, priority in modern feeding is given to whey proteins. However Scientific research proving the benefits of whey proteins over casein are unconvincing. Mixtures contain more proteins than breast milk, with a different ratio of amino acids. It is believed that casein promotes curdling, and that infants fed mixtures with great content whey proteins, spit up more often. Casein has been shown to goat milk promotes faster curdling and greater curd density than whey proteins. Residual gastric contents 2 hours after feeding when using casein proteins are greater than when feeding with a mixture based on whey proteins. This promotes slower gastric emptying and is associated with better curdling. Delayed gastric emptying from the casein blend compared to the whey protein blend resulted in Lately to the emergence of a “new” casein-dominant milk formula. It is recommended for feeding "hungry babies", due to the good saturating ability of casein. These mixtures are thickened with cereals and are thus used to treat regurgitation.
According to foreign researchers, it is advisable to use condensed or coagulated food. Coagulants are added to the milk mixture, for example, the carob preparation Nestargel. Locust bean gluten (gum) is a gel that forms a carbohydrate complex (galactomannan). Acacia gum is very popular in Europe.
Much evidence suggests that milk thickeners reduce the number and volume of regurgitation in infants. The rich rice blend is thought to improve sleep, possibly due to the good satiety associated with calorie utilization in the fortified food. Fortified milk formulas are well tolerated side effects are rare, as are serious complications.

Thus, due to their safety and efficacy in the treatment of regurgitation, milk thickeners remain among the priority interventions for uncomplicated reflux. Mixtures that have an anti-regurgitation effect are called AR-mixtures (anti-reflux, for example, Nutrilon). Most of them contain gum thickener in various concentrations, which is accepted as a food additive in special medical purposes for infants and young children, but not as a supplement to healthy children. The addition of dietary fiber (1.8 or 8%) to complementary foods has a cosmetic effect on stool (hard stool), but does not affect its volume, color, odor, calorie content, nitrogen absorption, absorption of calcium, zinc and iron. Pregelatinized industrial way rice starch is also added to some mixes. Corn starch has been added to a number of mixtures. The Scientific Committee of the European Council on Nutrition has adopted a maximum allowable amount of added starch of 2 g per 100 ml in adapted formulas.

But it must be remembered that “AR”-mixtures - medical products and should only be recommended by a doctor, in accordance with the rules for prescribing drugs.
Old school pediatricians previously recommended that a child with regurgitation take 1-2 teaspoons of 10% semolina porridge in water before feeding through one feeding (according to Epstein). This measure made it possible to prevent the development of gastrointestinal reflux in this group of babies.
When dietary measures and postural therapy fail, medications. Infants and young children are prescribed cisapride (cisapride, coordinatex, prepulsid), motilium.

In young children, the alginate-antacid mixture Gaviscon (an alginic acid derivative) has proven itself well. In the stomach, this drug forms a viscous anti-inflammatory antacid gel that floats like a raft on the surface of the gastric contents and protects the esophageal mucosa from aggressive contents. Gaviscon Baby is suitable for mixing with formula for bottle feeding.

Inflammatory lesion of the mucous membrane of the esophagus associated with gastroesophageal reflux is called reflux esophagitis. Very rarely, reflux esophagitis occurs as independent disease. As a rule, it is observed with a lesion upper divisions digestive tract - with peptic ulcer of the stomach and duodenum, chronic gastroduodenitis etc.
A number of factors predispose to the development of gastroesophageal reflux: stressful situations, neuropsychic overload, obesity, uncomfortable posture during meals and during the day, smoking (including passive), drinking alcohol and beer, diaphragmatic hernia, irrational intake of certain medications.
The intensity of the clinical manifestations of reflux disease depends on the concentration of hydrogen ions in the contents that enter the esophagus from the stomach and on the duration of contact of this contents (reflux) with the mucosa of the esophagus.

Clinical manifestations gastroesophageal reflux disease (GERD): pain V epigastric region, unpleasant feeling"Soreness, burning" behind the sternum immediately after swallowing food or during a meal. With severe pain, children refuse to eat. Chest pain may occur with brisk walking, running, deep bending, lifting weights. Often, children note pain behind the sternum and in the epigastric region after eating, aggravated in the supine or sitting position.
The most characteristic symptom is heartburn. It usually occurs on an empty stomach or after eating and is aggravated by physical activity. Children younger age can't describe the symptoms of heartburn. Other dyspeptic disorders may include nausea, loud belching, vomiting, hiccups, difficulty swallowing.
The so-called extraesophageal manifestations of GERD include reflux laryngitis, pharyngitis, otitis, nocturnal cough. 40-80% of children with gastroesophageal reflux have symptoms bronchial asthma, which develop due to microaspiration (inhalation) of gastric contents into the bronchial tree. Often a late dinner, a hearty meal can trigger GERD symptoms, and then asthma attacks.

Serious complications of reflux esophagitis are erosions and ulcers of the esophagus, followed by the development of a narrowing of the lumen (stricture) of this organ, as well as the formation of Barrett's esophagus.
Pathological changes in the organs gastrointestinal tract with violation of swallowing and a clinic of reflux esophagitis are also inherent in certain forms of systemic diseases of the connective tissue. The most clear clinical and morphological changes in the esophagus are found in scleroderma, dermatomyositis, periarteritis nodosa, systemic lupus erythematosus. In some cases, changes in the esophagus systemic diseases connective tissue precede the pronounced clinical symptomatology of the underlying disease, act as precursors.

Diagnostics GERD and reflux esophagitis is performed based on the history of the disease, clinical features and the results of instrumental and laboratory methods. The “gold standard” for diagnosing reflux esophagitis at the present stage is esophagogastroduodenoscopy with targeted biopsy of the esophageal mucosa. Endoscopic method allows you to identify swelling and redness of the mucous membrane of the esophagus, its erosive and ulcerative lesions. Abdominal ultrasonography is widely used. Among instrumental diagnostic methods, the most informative are 24-hour pH-metry and functional diagnostic tests (esophageal manometry). The combination of these methods makes it possible to assess the consistency of the lower esophageal sphincter in a patient by the duration of the acidic and alkaline phases in the standing and lying position, the pressure in the esophageal-gastric junction. It is also possible to conduct pharmacological tests, in particular, the introduction of alkaline and acidic solutions. Also in the diagnosis of GER in children great value represent radioisotope and X-ray functional studies, which include a water-siphon sample or a load with a gas-forming mixture. In recent years, the echography method has been used to detect gastroesophageal reflux.

Treatment GERD, given the multicomponent nature given state, complex. It includes diet therapy, postural, drug and non-drug therapy. The choice of treatment method or their combination is carried out depending on the causes of reflux, its degree and range of complications. Also timely diagnosis and adequate therapy for GERD can reduce the frequency of asthma attacks and improve the quality of life of patients with bronchial asthma.

As noted above, children with GERD and reflux esophagitis undergo postural therapy - eating in a position at an angle of 45-60 degrees, sleeping with the head end of the bed raised.
Patients should avoid deep inclinations of the torso, it is not recommended to perform gymnastic exercises with tension in the muscles of the anterior abdominal wall, lifting weights. Limit jumping and cycling. Wearing clothes with tight waistbands and tight elastic bands should be avoided.
It is very important to avoid passive smoking, and even more so, smoking by adolescent patients themselves. Drinking alcohol, even in very small amounts, negatively affects the tone of the lower esophageal valve and contributes to the aggravation of reflux.

Children with reflux esophagitis should eat 5-6 small meals a day. The last meal should be no later than 3-4 hours before bedtime. Foods that increase GER (coffee, fats, chocolate, etc.) should be avoided. In the diet, spicy dishes with spices, vinegar, sauces (adjika, mayonnaise, ketchup) are excluded or limited as much as possible. Limit the consumption of fatty and fried foods, as well as foods that stimulate bile secretion and gas formation (turnips, radishes, all choleretic herbs and etc.). Children are not allowed to eat dried fish, dried fruits with GERD. Dry food is very harmful, as it injures the inflamed mucous membrane of the esophagus. Carbonated drinks are completely excluded, chewing gums. It has been proven that chewing gum for a long time (more than 15-20 minutes) increases acid production in the stomach and reduces the tone of the esophageal-gastric valve, which contributes to reflux.
With severe reflux, it is recommended to eat while standing, after eating, walk for half an hour.

The use of antacids in children is clinically justified due to their neutralizing effect. Of the drugs in this group, Maalox and Phosphalugel deserve special attention (1-2 packets 2-3 times a day, for older children). high efficiency in the treatment of GER, smecta has (1 sachet 1-3 times a day). Usually, drugs are taken 40-60 minutes after a meal, when heartburn and discomfort behind the sternum most often occur.
In order to reduce the damaging effect of acidic gastric contents on the mucosa of the esophagus, ranitidine, famotidine are used.
Highly effective drugs that are called "proton pump inhibitors": omeprazole, pariet (rabeprozole). The most effective antireflux drug currently used in pediatric practice is "motilium". A promising drug for the treatment of dyskinetic disorders of the gastrointestinal tract in general and GER, in particular, is cisapride (“prepulsid”, “coordinax”).

In the treatment of reflux esophagitis, preparations containing alginic acid (alginates, sometimes they write - alginates) have proven themselves well. Alginic acid forms a foamy mixture that reduces the acidity of the contents of the stomach, and when it enters the lumen of the esophagus in case of reflux, it protects the mucous membrane of this organ. Preparations from this group - Gaviscon, Topaal.
In order to protect the mucous membrane of the esophagus and stomach from the action of aggressive factors of gastric juice, sucralfate (venter) is also used.
Russian gastroenterologists note good effect from the use of polyphytic oil "Kyzylmay" (Kazakhstan), which includes St. John's wort oil, nettle, wild rose, licorice, sea buckthorn, thyme, lemon balm.

Such tactics in GERD in children provides a long-term therapeutic effect and prevents complications. The lack of effect of conservative treatment for several months or years is an indication for surgical correction.

Barrett's esophagus is one of the complications of long-standing gastroesophageal reflux disease. This disease occurs in about one in ten patients with reflux esophagitis and refers to precancerous conditions. According to medical literature, in the Republican Children's Surgical Centers, Barrett's esophagus is diagnosed annually in 3-7 children with GERD.

In this disease, the cells of the squamous non-keratinizing epithelium of the esophagus are replaced by metaplastic (from the word metaplasso- transform, transform) cylindrical epithelium. The name "Barrett's esophagus" is therefore rather ironic, since it is given by the name of the English surgeon Norman Barrett, who in his work in 1950 argued that the esophagus cannot be lined with columnar epithelium.

The most reliable method for diagnosing Barrett's esophagus is the study of a portion of the mucous membrane of the lower esophagus, which is obtained by biopsy during endoscopic examination.
A predisposing factor for the development of Barrett's esophagus is low acidity with reflux.

characteristic clinical symptoms with Barrett's esophagus missing. This disease should definitely be excluded if the duration of the disease (reflux esophagitis) is more than 5 years and the effectiveness of conservative therapy is insufficient. Several cases of reduction have been described. pain sensitivity esophagus in patients with Barrett's esophagus, therefore, such patients do not experience heartburn and pain when gastric contents enter the lumen of the esophagus, which makes it difficult timely detection pathology.
In addition, in patients, a decrease in the secretion of epidermal growth factor with saliva, a special peptide (protein) involved in the healing process, was found. chronic ulcers and erosion of the mucosa of the esophagus.

When identifying Barrett's esophagus, a thorough search for foci of dysplasia is necessary (from the words dys + plasis abnormal, abnormal development) in the mucosa of the esophagus. If low-grade dysplasia is found, high-dose proton pump inhibitors (omeprazole) are given for 8 to 12 weeks to prevent further exposure of the esophageal mucosa to hydrochloric acid. With the disappearance of dysplastic changes, repeated endoscopic examinations carried out in a year. With the preservation of dysplasia and its progression, it is advisable additional consultations histologists (specialists in organ tissues) from different institutions. In case of confirmation of high-grade dysplasia, surgical treatment is indicated.

Sometimes laser, cryo- or thermal coagulation of the zone is used to treat Barrett's esophagus. But the most effective surgical method removal of a zone with an altered mucosal structure.

Up to 70% of children aged 3-7 months "return" the contents of the stomach more than once a day. The reason is that the milk reacts with stomach acid and is pushed out in the opposite direction, because the muscular valve is not yet sufficiently developed to contain burping.

Reflux is common in infants, especially in the first three months of life, but if the problem persists after this period or if you have any other cause for concern, see your doctor. This must be done without fail if the following symptoms appear:

severe constipation;
bloody or completely black stools;
blue face, suffocation;
resumption of bouts of vomiting after reaching the age of six months;
bloating;
vomiting of bile;
vomiting "fountain".

Symptoms and signs of gastroesophageal reflux (GER) in newborns under one year old

lack of gain or weight loss;
crying caused by abdominal pain;
irritability during or after feeding;
fatigue;
belching;
prolonged anxiety;
cough;
arching the back when eating or refusing to feed.

Another variation of this problem is called silent reflux, or laryngeal reflux. It is more difficult to identify because it does not have unambiguous external manifestations. However, babies who suffer from it may show signs of discomfort, irritability, or even pain when taking horizontal position. In addition, because stomach acid irritates the upper respiratory tract, reflux disease is often accompanied by chronic cough, sore throat, and hoarseness while crying.

Treatment of gastroesophageal reflux (GER) in newborns up to a year

Sometimes, to solve a problem, it is enough for a mother to adjust her own diet and the baby’s diet, but there are also additional tricks which, for example, helped my daughter a lot. I was glad that I managed to alleviate her condition without resorting to medical treatment.

If you are breastfeeding, then watch your diet. Some babies have unpleasant symptoms occur because the tiny digestive system cannot tolerate certain products. Eliminate food that can irritate the child's stomach (these are dairy products, soy, eggs, peanuts, gluten, caffeine, spicy foods), and try to determine if the child's well-being has changed. Eliminate several foods from the diet at once, and then return them one at a time, observing the reaction of the baby. Don't Eat Too Many Carbohydrates: A Low-Carb Diet Is Scientifically Proven effective way treatment of reflux disease, since the esophageal sphincter is controlled by insulin. Sugar is bad for a burping baby.
If the baby is breastfed, drink chamomile tea. The substances contained in chamomile, along with your milk, will go to the baby and relieve discomfort in his tummy.
Elevate the baby's head while feeding. Place a pillow under the back of his head so that the milk flows into the stomach and does not linger in the esophagus. Try to keep your baby upright after feedings and during activities such as changing a diaper or bathing.
Feed your baby little and often. Sometimes the symptoms are aggravated by the fact that the child takes too much food at once. In such cases, reducing the "portion" helps. If you are breastfeeding and milk going strong jet, choose a position in which the baby can receive exactly as much food as he needs. Don't forget to help your baby breathe out after each feed. In this case, it is desirable to keep the child upright.
Carry your baby on your back or on your stomach using a backpack that allows your baby to be upright and not put pressure on the stomach. This will reduce the frequency of spitting up.
Massage your baby. This activates the immature digestive system and helps to shape it. To relieve discomfort and achieve a soothing effect, you will need about 30 ml of organic massage oil for babies with the addition of a drop of lavender or chamomile oil.
Refer to homeopathy. A proven remedy for preventing reflux in infants is Natrium Phosphoricum at a 6x dilution (six times decimal dilution). Dissolve one tablet in milk and give to your child immediately after feeding. Or if you are breastfeeding, then take this medicine yourself 2 tablets after each meal: it will have a mild effect on the baby, having naturally entered his body with your milk. Before using the drug, consult an experienced homeopath.

Gastroesophageal reflux may be more common in children than in adults. GER is a process in which food that has already entered the stomach or small intestine is thrown back into the esophagus.

1 When can this phenomenon be considered normal?

At baby it could very well be normal because its digestive system is different from an adult. Reflux in newborns helps to remove excess food and air from the body, which the baby swallows with milk. GER in children thus serves as a safeguard against too much food entering the child's stomach, because it will not be digested as it should be, and its exit to the outside is in a sense even necessary. If such a cast had baby did not happen, then the food would begin to ferment in the stomach, causing pain and discomfort.

As for the air, its exit prevents unpleasant and pain in the area of the diaphragm. If excess air remains in the child's body, then the pressure inside also increases, that is, the child does not feel well. Because reflux is physiological mechanism which is natural and necessary.

GER in children under one year old is the norm. Closer to six months, the baby begins to slightly change the organs of the digestive system, the work of the glands is rebuilt, motor skills and sphincters change. By the year the reflux in the child should disappear, but isolated cases may still be observed.

2 Need for medical attention

If Reflux Doesn't Go Away long time, then this may indicate the following problems:

Abnormal development of the esophagus, which may be too short, very dilated, or herniated.
Bending of the gallbladder can lead to the reflux of food into the esophagus.
Binge eating. If parents forcibly force a child to eat, then this does not lead to anything good, but provokes a weakening of the sphincter, which in turn leads to improper functioning of the stomach.
Gastroesophageal reflux can occur as a result of uncontrolled and long-term use some medical preparations, especially with the content of theophylline.
Violation of the diet.
Frequent stress and negative emotional experiences can also add to the fact that an increased production of hydrochloric acid will begin, and this leads to reflux.
Constipation.

If a child has regurgitation or vomiting after eating, pain and discomfort in the gastric region, constipation and bloating occur, then this is a reason to see a doctor.

Almost all parents do not attach any importance to the child's hiccups, and this is also one of the symptoms in children. Naturally, it is necessary to sound the alarm if hiccups torment the child often and for a long time.

Parents should know that if food is thrown into the bronchi, then the baby often suffers from bronchitis, he may experience a cough of unknown etiology. When a child gains weight poorly or loses it abruptly, you should also contact your pediatrician.

It is necessary to show the child to the doctor if he became lethargic, apathetic, lost interest in toys, or vice versa, there was no motivated aggression. If the child spits up, or he vomits after eating, and at the same time the parents notice hoarseness in his voice, or the child complains of a sore throat, but there is no reddening of the tonsils, then this is also a pathological phenomenon.

Symptoms of gastroesophageal reflux in preschool and primary school children are manifested in the form of vomiting or a taste in the throat of stomach acid, some children complain of a feeling that a lump is stuck in the throat.

If a child is prone to asthmatic phenomena, then with reflux, he may experience difficulty breathing. Older children and teenagers may complain of a sour taste in the mouth, nausea, pain when swallowing, a burning sensation in the chest (which is heartburn), and a feeling of difficulty moving food through the esophagus.

3 Diagnosis of pathology

In order to make a diagnosis of gastroesophageal reflux, the pediatrician must conduct a thorough examination of the patient. If the baby is healthy and reflux occurs infrequently, most likely this phenomenon is temporary, and additional examination is not required. The doctor can simply give some advice to parents regarding the child's nutrition.

If the child is of school age, then a trial treatment for reflux is prescribed, and only then it makes sense to conduct a study. With ineffective treatment or slow growth of the baby and minimal weight gain, a comprehensive examination is necessary. It includes:

endoscopy, when the doctor examines in detail the mucous membrane of the esophagus;
radiography with contrast agent- the procedure allows to examine the structure of the stomach and esophagus;
pHmetry of the esophagus allows you to find out how much acid-base balance in the esophagus is close to normal or far from it.

4 Methods of therapy

Diagnosis of a disease is not the only problem doctors and parents. Treating reflux in children is quite difficult. Drugs that are prescribed for this disease for adults should not be taken by children. Therefore, the treatment of the disease in a child should be approached comprehensively:

It is necessary to regulate the nutrition of the child. Food should be fractional and small portions. Overfeeding is strictly prohibited.
Do not put the child to sleep immediately after eating.
To do it right, you need to know the reason why it arose and eliminate it.

For medications, doctors sometimes recommend getting a small course of antacids and proton pump inhibitors. If a hernia is diagnosed in a child, then it must be removed surgically.

As for older children, some foods should be excluded from their diet: mint, chocolate, caffeine help to relax the muscles of the esophagus, which allows acid to penetrate into it and provoke inflammatory processes. Sour drinks, cola, Orange juice can also exacerbate reflux symptoms. It is worth limiting the consumption of french fries and other fatty foods, because they slow down the process of emptying the stomach and provoke reflux.

You can try to raise the head of the bed by 15-25 cm. Such measures are effective for nighttime heartburn: if the head and shoulders are higher than the stomach, then gravity will not allow acid to rush into the esophagus. It is better not to use a large number of pillows, but to put wooden blocks along the legs of the bed from the side of the headboard, because the child will not have an unnatural bend in the body. If the child has overweight body, then it is necessary to achieve a decrease in it, perhaps a hundred then the symptoms of GER will decrease.

5 Preventive approach

To minimize the risk of developing pathology, parents should follow simple rules in feeding children:

It is advisable not to feed the baby too much fatty foods also reduce the intake of salty and smoked foods. It is necessary to serve food to the child in a warm form, hot and cold children are not recommended to eat.
It is advisable to avoid highly acidic juices because the acid promotes over-fermentation of the digestive system. Carbonated water and sugary carbonated drinks provoke burping, which also negatively affects the digestive system.
Parents should be aware that smoking around a child can cause nausea. It is worth feeding the child no later than 3 hours before bedtime, and if the child is prone to spitting up, then for a while you can put him a pillow higher, and after two hours, replace it with a regular one.
Be sure to monitor the weight of the child. Try to dress your baby so that the clothes do not pinch abdominal cavity. If he needs to take pills, make sure he takes them. enough liquids. With vomiting, it is necessary to consult a doctor in a timely manner.

It is not necessary to delay the diagnosis and treatment of gastroesophageal reflux in children, this pathological condition can lead to weakening of the muscles of the esophagus, and, as a result, to problems with the digestive system.

Esophagitis in children is a fairly common pathology among diseases of the esophagus. It is characterized by inflammation of the mucosa. With a severe degree of development, the deeper layers of the esophagus undergo changes. Esophagitis can develop as an independent disease, or occur against the background of other diseases. The cause of the manifestation of the disease is the release of stomach contents into the esophagus (reflux). If the condition recurs, serious consequences are likely to occur: the formation of ulcers, scarring of the esophagus, its narrowing or shortening. Over time, the disease can lead to oncological pathologies.

Reflux observed in infants, in most cases, is not considered a pathology, since it is caused by a weak muscular system esophagus and sphincter, sphericity and small size of the stomach, its rapid filling and slow emptying. Therefore, for the first 3 months of life in infants, regurgitation after eating, hiccups are considered commonplace. The condition does not require treatment, you need to feed the baby at an angle of 60 degrees, after feeding it is necessary to keep him in an upright position so that the air that has entered the stomach is released. You need to put the baby on the barrel so that when regurgitation, the food mass does not enter the respiratory tract. With a tendency to frequent reflux, the child should be put to bed so that top part the body was slightly higher. You can put it on your pillow.

Preventive measures can prevent the development of esophagitis.

Diagnosis of reflux esophagitis in childhood quite difficult, because the child cannot explain what is causing him anxiety. Treatment of esophagitis in children is also difficult because many medications are not allowed to be used in childhood.

Esophagitis is inflammatory process caused by the ejection of stomach contents into the esophagus. Under normal conditions, the contents of the stomach cannot enter the esophagus, since the muscular sphincter in the lower part of this organ is closed and prevents this. It opens in time to enter food into the stomach and closes in time. When the function of the sphincter is impaired and the muscle ring does not close completely, then gastric juices and acids enter the esophagus along with digested food. Contact of the contents of the stomach with the mucous membrane causes the development of reflux esophagitis.

Reflux esophagitis also manifests itself in healthy children, while the condition is of a short-term nature, so the child does not feel changes and discomfort.

When the state repeats in a periodic manner, causing bad feeling child, you need to seek medical attention.

What it looks like, photo

As a result of the development of reflux esophagitis, you can see changes in the contours of the esophagus, ulceration, swelling of the walls and accumulation of mucus.

At normal functioning the muscular ring opens the lumen for the passage of food into the stomach through the esophagus and closes it tightly in a timely manner, since the peristalsis of the sphincter is not disturbed.

When the muscle ring is weakened and its functionality is impaired, a pathological condition is observed. Stomach acid returns to the esophagus with food. Gastric juice in the composition of the mass coming back causes irritation and inflammation of the mucous membrane of the esophagus. As a result of an anatomical anomaly, the stomach protrudes through a weakened diaphragm.

Symptoms

In infants, the cause of reflux may be an overflow of the stomach with food, rarely - food allergies, narrowing esophageal opening. Children may have congenital or acquired pathologies of the digestive system.

In older children, reflux develops as a result of gastroduodenal diseases, mainly with insufficiency of the cardiac sphincter, with acute or chronic gastritis, with a stomach ulcer and 12 - intestinal rings. In school-age children, reflux can develop as a result of irregular eating and excessive consumption of sweets, fatty foods, sweets.

Parents should be attentive to the child's complaints when they notice anxiety, refusal to eat for a long time. Symptoms of the disease may be non-specific, it can be confused with other diseases. The child may experience:

Reflux is almost always found in newborns. Regurgitation is considered normal when they are rare and the baby does not lose weight. In a healthy child, reflux rarely appears after the 4th month, and completely disappears by the 10th month. During this period, the condition does not require treatment. If after that the child has reflux recurs, you need to see a doctor. In infants, the disease occurs:

colic;
The formation of gases in the intestines and the difficulties of their discharge;
Repeated swallowing of food.

In some cases, reflux can be dangerous to health. Urgently consult a doctor if you observe the ineffectiveness of conventional medicines against reflux and if the baby is losing weight rapidly. anxiety symptoms are:

Difficulty in swallowing food;
Black color of vomit or traces of blood in them;
Sudden fever;
Hiccups that do not go away for a long time;
Chair in black.

signs

Signs of gastroesophageal reflux in children under 5 years of age can manifest themselves in different ways. The baby may complain of an unpleasant bitter-sour taste in the mouth, may refuse to eat, because pain appears after each meal. The child's breathing becomes difficult, especially when little patient suffers from asthma, begins to lose weight, vomiting appears.

In older children and adolescents, it is easier to determine the disease, as they can characterize pain, discomfort. Specific features are:

Taste of acid in the mouth or in the esophagus;
Nausea;
Heartburn, burning and pain in chest(in the middle of the chest);
Pain during meals;
Feeling of poor passage of food through the food pipe.

The pain may worsen during sleep.

Signs of the disease in one-year-old children are arching of the back or neck from a feeling of pain, gushing vomiting, refusal to feed, crying before and after feeding.

Classification and degrees

Pathological reflux occurs in acute and chronic form.

The acute form of the disease develops against the background of existing diseases of the gastrointestinal tract. The main symptoms of this form are disruption of the gastrointestinal tract, the presence of a focus of infection in the body, vitamin deficiency. The baby looks unhealthy, there are difficulties in swallowing, pain in the chest.

The chronic course of the disease manifests itself as a complication of another disease of the digestive system. Infrequently, esophagitis occurs primarily, due to the specifics of nutrition. leaking chronic form reflux with severe symptoms.

Depending on the nature of the disease in a child, the following types of reflux are classified:

There are four degrees of development of the disease. Symptoms and treatment regimen depend on the degree.

In the first degree of pathological reflux, irritation of the esophagus by the contents of the stomach is observed. Under the influence of an aggressive substance contained in the mass, the mucous membrane of the esophagus swells, becomes red, single erosive lesions are recorded. Symptoms at this stage are absent or mild.
In the second degree, esophagitis occurs with certain symptoms, which is associated with erosive lesion mucosa of the esophagus. On the mucosa there are spots 3-6 mm in size, which sometimes merge, gradually capturing the entire surface of the esophagus.
The third degree of pathology in a baby is characterized by severe symptoms. Difficulty in the process of swallowing, severe pain, the formation of defects on the mucosa of the esophagus, and a feeling of discomfort in the stomach area are recorded. With this degree, the lesion of the esophagus occupies more than 70%. Ulcerative lesions coalesce. The child complains of a burning sensation and heaviness in the chest, especially after eating.
The fourth degree is expressed by scale ulcerative lesion esophagus (more than 75%). Symptoms are more pronounced, constantly disturbing the child. The patient complains of pain in the stomach area, an unpleasant aftertaste in the mouth, swallowing becomes impossible against the background of severe discomfort and burning. This stage is the most dangerous and difficult for the baby, since this is a trait after which there is a risk of developing gastrointestinal cancers.

Pathological reflux is detected in most cases from the second degree, when the symptoms become pronounced. In the third and fourth degree, surgical intervention is often resorted to.

Extraesophageal manifestations include:

bronchopulmonary;
Otolaryngologically;
Cardiology;
Dental.

ICD code 10

According to the ICD - 10 ( international classification diseases), esophagitis refers to diseases of the esophagus, stomach and 12 - rings of the intestine. Reflux - esophagitis according to ICD - 10 has a classification of K 21.0 - reflux with esophagitis, K 21.9 - without esophagitis.

The Savary Miller classification is also applied:

Grade A. The affected area of the esophagus reaches up to 4 mm, ulcers are observed that do not merge with each other;
Grade B. The affected area is enlarged to 5 mm. Erosive areas can merge in places;
Grade C. The area affected by ulcers reaches up to the 5th part of the esophagus;
Degree D. The esophagus is affected by 75%.

Clinical recommendations of pediatricians are based on the study of anamnesis, clinical and laboratory data and the results of instrumental studies. With the help of anamnesis, the pediatrician is able to establish the presence of dysphagia, a wet spot symptom, and other typical manifestations. In the KLA, a decrease in the level of erythrocytes and hemoglobin (with posthemorrhagic anemia) or neutrophilic leukocytosis and a shift leukocyte formula to the left (with bronchial asthma).

The doctor prescribes endoscopic diagnostics- fibrogastroduodenoscopy, which allows to detect pathology on the mucosa, take biomaterial for research, see anatomical anomalies of the esophagus, assess the condition of the stomach.

Pressure is also measured inside the gastrointestinal tract, ultrasound, contrast x-ray examination, which reveals hernias, narrowing, evacuation dysfunction of the upper gastrointestinal tract. The procedure is important daily measurement ph inside the esophagus.

Treatment regimen

If gastroesophageal reflux disease is not complicated (first or second degree), infants are treated with a simple change in diet:

Reduce portions of food, overeating should not be allowed;
Exclude contact of the baby with tobacco smoke;
Whole milk is removed from the diet.

If a child has abundant and frequent regurgitation, this can lead to dehydration and a violation of the water and electrolyte balance. In such cases, the treatment of the baby is organized in stationary conditions using infusion solutions.

Not for children infancy treatment is chosen by narrow specialists on the basis of research, taking into account the individual specifics of the child's body.

The following groups of medicines are used:

PPIs are proton pump inhibitors. Block the formation of hydrochloric acid. Apply Omeprazole, Pantaprazol. Omeprazole is recommended for the treatment of children from 2 years of age.
H2 blockers - histamine receptors. Reduce the acidity of gastric juice. These include Ranitidine, Famotidine. It is not allowed to use for the treatment of children under 1 year.
Antacids. Neutralize hydrochloric acid, restore damaged areas of the mucosa. Phosphalugel, Maalox, Gaviscon are prescribed.
Prokinetics. They activate the contraction of the muscles of the stomach, increase the tone of the esophageal sphincter, normalize the process of gastric emptying, reduce reflux.
Enzyme medicines that help digest food.
Medications to combat flatulence. The use of Melikon is recommended.

The above drugs are used in symptomatic therapy but do not eliminate the cause of the disease.

In most cases, the third and fourth stages of reflux esophagitis require surgical intervention.

The indications for surgery are:

Ineffectiveness of long-term drug treatment;
Severe pain syndrome (pain does not subside after taking painkillers);
Deep damage to the mucosa, when multiple erosions and ulcers are fixed, occupying a large extent of the organ;
aspiration syndrome;
severe obstruction respiratory tract(complication of esophagitis).

The operation is performed by laparoscopic fundoplication, during which the sphincter muscle in the lower part of the esophagus is strengthened.

Folk remedies

For the treatment of esophagitis in children, herbal teas and decoctions from medicinal herbs. Before using prescriptions traditional medicine be sure to check the reaction of the baby's body to the compositions used and consult a doctor.

Collection of thyme and marshmallow

In equal quantities, thyme and marshmallow rhizomes are taken. 40 g of the collection is poured into 250 ml of boiling water and infused for 2 hours.

Tincture of mint, valerian and celandine

Cooking herbal collection mint, valerian, celandine (2:2:1). 20 g of the collection is poured into 250 ml of boiling water and heated in a water bath for 20 minutes.

dill tincture

2 tsp. Ground dill seeds pour 200 ml of boiling water, insist 3 hours. The infusion is consumed after straining, 3 times a day, 1 tbsp. l. before eating.

Useful sweet water or water on flower honey (1 tbsp. Product for 1/3 warm water), which is prepared at night and given to the child in the morning.

Prevention

To prevent the development of esophagitis in children, you need to monitor their lifestyle and regimen. You can’t smoke with a child, teenagers need to explain the harm of smoking and alcoholic beverages to the body. The diet of the baby should include only healthy foods need more fresh vegetables, fruits.

It is necessary to feed the child after checking the temperature of porridge, drinks. Very hot or cold food is not allowed. To avoid chemical burns household chemicals must be kept out of the reach of children. During the treatment period, a sparing diet is recommended. Regular examinations by narrow specialists are advised, which will give the opportunity to detect and treat the pathology in a timely manner, preventing possible complications.

All parents should remember that self-medication is dangerous for the health of the child.

Diet

For infants the best option is breastfeeding. Food thickeners (corn, potato, rice starch) are added to the menu. This will help prevent food from leaking from the stomach into the esophagus. According to the version of American scientists, in the food of a child from 0 to 3 months, you can add a maximum of 1 tablespoon of a thickener per 30 ml of liquid.

For children preschool age and adolescents use a sparing diet. The diet is made taking into account that food intake is regular and crushed. You need to eat 6 times a day, in small portions at exactly the right time.

The child should eat only freshly prepared meals from foods that are easy to digest. It is necessary to exclude legumes, fibrous products, fruits with skin.

All drinks and dishes should be used in a warm (non-hot) form, since the inflamed mucosa is sensitive to the temperature of the food used.

It is advised to include soups from cereals, vegetable broths, boiled and chopped meat and fish, pureed cereals, kissels in the diet. Do not give your child rich soups, spicy, spicy, sour dishes. It is forbidden to use sweets with dyes, chocolate, fast food, sausages, fresh bread, sweets, carbonated drinks. Water should be given little by little, but regularly.

Treatment of esophagitis in children is complicated by the fact that small patients find it difficult to explain what worries them. Parents should be attentive to the behavior of the child, at the first sign of digestive problems, contact a specialist. Timely treatment child prevents the transition of the disease to a more complex degree of development, gives the opportunity to quickly and effectively cure the child using medicines.