Gastroesophageal reflux in children. Gastroesophageal reflux in newborns and children. Gastroesophageal reflux: symptoms in children

Gastroesophageal reflux disease (GERD) in children- a chronic relapsing disease that occurs when retrograde throwing of the contents of the stomach and the initial sections of the small intestine into the lumen of the esophagus. Main esophageal symptoms: heartburn, belching, dysphagia, odynophagia. Extraesophageal manifestations: obstruction bronchial tree, disorders of the heart, dysfunction of the ENT organs, erosion of tooth enamel. For diagnosis, intraesophageal pH-metry, endoscopy and other methods are used. Treatment depends on the severity of GERD and the child's age, and includes dietary and lifestyle changes, antacids, PPIs, and prokinetics, or fundoplication.

General information

Esophageal stenosis is a narrowing of the lumen of the organ resulting from the process of scarring of ulcerative defects of the mucous membrane. Simultaneously in the background chronic inflammation and involvement of periesophageal tissues, periesophagitis develops. Posthemorrhagic anemia is a clinical and laboratory symptom complex that appears as a result of prolonged bleeding from esophageal erosions or pinching of intestinal loops in the esophageal opening of the diaphragm. Anemia in GERD is normochromic, normocytic, normoregenerative, the level of serum iron is somewhat reduced. Barrett's esophagus is a precancerous condition in which the squamous stratified epithelium characteristic of the esophagus is replaced by a columnar epithelium. Detected in 6% to 14% of patients. Almost always degenerates into adenocarcinoma or squamous cell carcinoma of the esophagus.

Diagnosis of GERD in children

Diagnosis of gastroesophageal reflux disease in children is based on the study of anamnesis, clinical and laboratory data and the results of instrumental studies. From the anamnesis, the pediatrician manages to establish the presence of dysphagia, the wet spot symptom, and other typical manifestations. Physical examination is usually uninformative. In the KLA, a decrease in the level of erythrocytes and hemoglobin can be detected (with posthemorrhagic anemia) or neutrophilic leukocytosis and a shift of the leukocyte formula to the left (with bronchial asthma).

the gold standard in GERD diagnosis considered intraesophageal pH-metry. The technique makes it possible to directly identify GER, assess the degree of damage to the mucous membrane and clarify the causes of the pathology. Another mandatory diagnostic procedure is EGDS, the results of which determine the presence of esophagitis, the severity of esophagitis (I-IV) and esophageal motility disorders (A-C). X-ray examination with contrasting makes it possible to confirm the fact of gastroesophageal reflux and to detect a provoking pathology of the gastrointestinal tract. If Barrett's esophagus is suspected, a biopsy is indicated to detect epithelial metaplasia. In some cases, ultrasound, manometry, scintigraphy and esophageal impedancemetry are used.

Treatment of GERD in children

There are three directions of treatment of gastroesophageal reflux disease in children: non-drug therapy, pharmacotherapy and surgical correction cardiac sphincter. The tactics of a pediatric gastroenterologist depends on the age of the child and the severity of the disease. In young children, therapy is based on a non-pharmacological approach, including postural therapy and nutritional correction. The essence of treatment with the position is to feed at an angle of 50-60 O, maintaining an elevated position of the head and upper torso during sleep. The diet involves the use of mixtures with antireflux properties (Nutrilon AR, Nutrilak AR, Humana AR). Expediency drug treatment determined individually, depending on the severity of GERD and general condition child.

The treatment plan for GERD in older children is based on the severity of the disease and the presence of complications. Non-drug therapy consists in the normalization of nutrition and lifestyle: sleep with a head end raised by 14-20 cm, weight loss measures for obesity, exclusion of factors that increase intra-abdominal pressure, a decrease in the amount of food consumed, a decrease in fats and an increase in proteins in the diet, refusal use of provocative medications.

The list of pharmacotherapeutic agents used for GERD in pediatrics includes inhibitors proton pump– PPIs (rabeprazole), prokinetics (domperidone), motility normalizers (trimebutine), antacids. Combinations of medicines and prescribed regimens are determined by the form and severity of GERD. Surgical intervention is indicated for pronounced GER, ineffectiveness of conservative therapy, the development of complications, a combination of GERD and hiatal hernia. Usually, a Nissen fundoplication is performed, less often - according to Dor. With the appropriate equipment, laparoscopic fundoplication is resorted to.

Forecast and prevention of GERD in children

The prognosis for gastroesophageal reflux disease in most children is favorable. During the formation of Barrett's esophagus, it is noted high risk malignancy. Typically, development malignant neoplasms in pediatrics is extremely rare, but more than 30% of patients in the next 50 years of life in the affected areas of the esophagus develop adenocarcinoma or squamous cell carcinoma. Prevention of GERD involves the elimination of all risk factors. Main preventive measures are a balanced diet, the exclusion of the causes of a long-term increase intra-abdominal pressure and limiting the use of provocative medications.

Reflux in children is a specific pathology in which the contents of the stomach begin to move back into the esophagus. It is reflux that is the main cause of regurgitation and frequent vomiting.

The main cause of the violation is dysfunction of the lower sphincter, if this organ is compressed and unclenched out of time, there is increased likelihood that the incoming food will be passed up into the esophagus.

Provoking factors

Reflux development

Experts say that reflux in infants most often develops due to an excessive amount of food in the stomach.

It must be understood that in newborns, the muscles of all organs, including the stomach and esophagus, are too weak, they simply cannot cope with their functions.

If the stomach is full, it will try in every possible way to get rid of excess products, and will begin to transfer them back to the esophagus. Another common cause of reflux in babies is an allergy to certain foods or a small esophagus.

Children have more middle age pathology often occurs due to such violations:

acute or chronic gastritis;
insufficiency of the cardiac sphincter;
problems with nervous system;
hiatal hernia;
the presence of excess weight;
paralysis of the diaphragm;
stomach ulcer.

Experts also warn parents that excessive consumption of various sweets - sweets, chocolate, buns, jam, marshmallows, as well as foods high in fat can also provoke gastroesophageal reflux.

The results of excessive consumption of sweets can be deplorable.

Symptoms of the disease

Gastroesophageal reflux disease is always accompanied by the same symptoms, regardless of what form and degree of pathology the patient has encountered. In international medicine today, physicians distinguish two forms of this disease.

Acute - the disease is accompanied by an increase in body temperature, the appearance of pain in the chest and increased salivation. With this form, the patient experiences severe discomfort when swallowing food and a burning sensation in the esophagus.

Chronic. If reflux is not treated on time, it will become chronic. It is impossible to cure the disease at this stage, it will entail not only the occurrence of painful sensations, but also provoke breathing difficulties and cause constant vomiting.

Abdominal pain in a child with reflux

Additionally, reflux in children and adults is often catarrhal and erosive. At catarrhal form inflammation occurs only on the surface of the mucous membranes, but does not destroy soft tissues.

In the erosive form, small erosive lesions form on the mucosa of the esophagus, provoking a degenerative process. With erosive reflux, the symptoms will be pronounced, the patient will experience discomfort and pain. most time.

Reflux in children and adults has 1, 2 and 3 degrees, depending on how many mucous tissues are affected by ulcerative neoplasms.

The manifestation of reflux in children

Doctors warn that in order for the treatment of the disease to be successful, it is necessary to start fighting it on initial stage. That is why every parent should be aware of the signs of reflux in children:

regurgitation;
babies 3-5 years old complain of a bitter taste in the mouth;
the occurrence of burning and tingling in the chest;
slight delay in development.

But at the initial stage, pain and discomfort will occur only after eating.

Diagnosis of the disease in children

If the symptoms of reflux in infants, which is complicated by esophagitis, do not disappear within 5-7 days, but at the same time increase, it is recommended to immediately sign up for an examination with a doctor.

To accurately identify the clinical picture, the physician will not only take an anamnesis and physical examination of a small patient, but also prescribe examinations and tests.

X-ray - it is carried out using barium sulfate - a special contrast agent.

Esophagogastroduodenoscopy - a popular type endoscopic examination, it gives the physician the opportunity to visually assess the condition of the esophagus and stomach cavities.

ph test - this test is rather unpleasant, as it is carried out using a tube with a probe, at the end of which there is a tiny camera.

Only after the doctor is sure that the child has encountered esophagus reflux, parents will be able to select the treatment.

When is medical intervention required?

The danger of reflux in children is that many parents confuse this disease with other disorders and begin self-medication at home.

Because of such unreasonable actions, the disease begins to develop, and the baby's condition only worsens. Experts warn that in order to avoid complications, the child must be shown to the doctor, after the diagnosis, the specialist will select the optimal method of treatment.

It is especially important to do this when the following symptoms appear:

the child complains of difficulty swallowing food;
fecal masses have acquired a dark shade;
there are streaks of blood in the vomit;
prolonged hiccups;
the baby has a fever and does not fall for more than 3 days.

Seek medical attention if symptoms occur

Especially parents should be alerted by the factor if the baby eats, but at the same time gradually loses weight.

Causes of reflux in babies

Doctors note that reflux in newborns most often occurs due to initial anatomical disorders in the esophagus or stomach, and it can also be a consequence of autonomic nervous regulation dysfunction.

Among the common causes of childhood reflux, doctors distinguish the following symptoms:

Problems with the formation of the digestive tract.
If parents hold the spoon incorrectly or feed the baby in the wrong position, food will enter the stomach with more air, causing aerophagia.
Overfeeding.
Acquired pathologies of the digestive system.

Causes of illness in preschool children

Gastritis as one of the causes of reflux

Reflux in children after 6–7 years of age often develops when gastroduodenal pathologies appear, such as gastritis, an ulcer, or underdevelopment of the sphincter.

In order to accurately identify what caused the disease and choose a competent treatment method, you will need to make an appointment with a specialist and undergo an examination. As practice shows, quite often acid reflux occurs due to excessive consumption of products that relax the lower sphincter - all kinds of sweets and foods high in fat.

Reflux Treatment

The method of treatment will be selected depending on the form and stage of reflux. Most often, modern medications are chosen as the main therapy, but if the disease is neglected, surgical intervention will be the only way out. To combat reflux, drugs of several pharmaceutical groups are most often prescribed.

Antisecretory drugs - their main purpose is to reduce acid in the gastric juice, but they also help reduce heartburn and relieve irritation from the walls of the esophagus.

Omeprazole and Famotidine are considered popular and effective drugs in this category. It is important to remember that the drugs are very active, so only a physician should select their dosage and duration of the course of treatment.

Prokinetics increase the tone of the sphincter esophagus. Most often, doctors prescribe Domidon and Motilium for the treatment of babies.

Histamine neutralizers reduce the percentage of gastric juice production.

Antacids neutralize the action of hydrochloric acid in gastric juice, especially with an excess of the substance. Medicines of this group are prescribed only to those babies whose age is more than 4 years. Known medicines are Rennie, Maalox and Almagel.

It must be understood that all these drugs can cause various side effects, so treatment should be carried out very carefully.

Pathology prevention method

Prevent reflux in infants and save the baby from unpleasant consequences the following measures will help:

So that the baby is not hungry, it is better 5-6 times a day, but the portions should be small.
Before starting feeding, the baby should be put on the tummy for 5 minutes, this contributes to the release of gases.
The child needs to be fed only in a sitting position, and in a horizontal position it is forbidden.
In order for food to be properly distributed and assimilated, during feeding, the baby needs to loosen swaddling.
After the child has eaten, he must be held in vertical position about 20 minutes, this will help the trapped air to come out.

One of the methods of preventing the disease, laying the baby on his stomach before feeding

If the baby has the initial stage of reflux, it is recommended to feed him only thick food. Despite the fact that the prevention of childhood reflux is not difficult, it is really very effective and helps prevent the onset of the disease.

Features of surgical intervention

Surgical treatment is prescribed very rarely, doctors resort to it only in cases where drug treatment is ineffective and does not bring improvements for a long time.

Experts assure that the operation for reflux most often takes place without any complications, its main task is to restore the anatomical function of the esophagus. But it must be remembered that the process is in any case quite risky, so before agreeing to such a decision, you need to think it over carefully.

Childhood reflux is quite unpleasant and dangerous disease. That is why parents should constantly monitor their baby, and in case frequent regurgitation and vomiting consult an experienced pediatrician immediately.

Video: Gastroesophageal reflux disease in children

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Diseases of the digestive system overtake not only adults, but also children. Sometimes they can appear due to an unhealthy diet, and sometimes due to the characteristics of the organism itself. One of these diseases is reflux esophagitis in children: the symptoms and treatment of this disease will be discussed in detail in this article.

Its other names are gastroesophageal reflux, gastroesophageal reflux disease (GERD), gastroesophageal reflux, acid reflux. In children, this disease can develop even up to a year.

Reflux esophagitis: what is it in children

Gastroesophageal reflux is an inflammatory process that occurs due to the release of stomach contents into the esophagus. The body uses hydrochloric acid to digest food. If the gastric mucosa can withstand such a level of acidity, then the esophageal mucosa begins to be injured when exposed to hydrochloric acid.

When food enters the esophagus, it redirects it to the stomach with soft wave-like movements of its walls. There is a lower esophageal sphincter between the esophagus and stomach. It is a muscular ring that must open in time to allow food to enter the stomach.

Another function of the lower food sphincter is the timely closure of this opening. When the sphincter is poorly closed, gastric juices and acids enter the esophagus along with digested food.

Reflux esophagitis can also appear in healthy children. This process can be short-term, so the baby will not even feel any negative symptoms.

If this situation is repeatedly repeated and causes the baby to feel unwell, then this problem must be dealt with already with medical help.

Gastroesophageal reflux: symptoms in children

If in adults the symptoms of this disease are quite similar, then in children different ages Reflux esophagitis can manifest itself in many different ways. Parents should observe the change in the behavior of the crumbs and his health, since symptoms will help determine the presence of this disease.

Symptoms of a disease such as reflux esophagitis in a child under 5 years of age are as follows:

an unpleasant bitter-sour taste or smell in the child's mouth;
vomit;
lack of appetite, as pain appears after each meal;
weight loss of the child;
pain in the center chest;
shortness of breath (this symptom is pronounced in children with asthma).

Symptoms of a disease such as gastroesophageal reflux in an older child and adolescents are much easier to determine, since children themselves can characterize their pain or discomfort.

Often GERD at this age manifests itself in the form of:

Babies up to a year old can be naughty, refuse food, often hiccup after eating, show or stroke the sternum. The pain may worsen even during sleep. The baby may feel soreness or burning immediately after eating if he is immediately put to bed after feeding.

Reflux esophagitis in a child: Dr. Komarovsky

Doctor Komarovsky considers gastroesophageal reflux in infants, as well as in children under one year of age, to be common physiological phenomenon. At this age, the baby's body has not yet fully formed distal esophagus, which would hold the contents of the stomach. In addition, at this age, the volume of the stomach is relatively small, and its shape is round. All this provokes regurgitation and vomiting after eating. Such symptoms occur spontaneously and abruptly.

Over time, when introduced into the diet solid food, such reactions of the body should stop. The antireflux barrier is fully developed, which prevents gastric contents from entering the esophagus.

In older children, this disease can develop for various reasons:

Due to excessive and frequent consumption of food. Parents can overfeed the baby, and sometimes he accustoms himself to large amounts of food.
Excess production of hydrochloric acid. Also for this reason, pyrolospasm and gastrostasis can develop.
After eating, the baby immediately assumes a horizontal position.
Increased intragastric pressure. This may be due to wearing tight clothing, a belt, or drinking a lot of carbonated drinks.

All of the above reasons provoke different symptoms in children.

Dr. Komarovsky notes that parents should pay special attention to symptoms that appear in the morning and immediately after eating.

With esophageal gastric reflux children may have:

constipation;
hiccups
cough immediately after waking up;
belching after eating;
bitter smell from the mouth;
snoring during sleep;
deterioration of tooth enamel;
heartburn;
chest pain;
regurgitation.

Special attention should be paid to non-food symptoms of reflux. In some cases, this disease can cause frequent otitis media, laryngitis and pharyngitis.

Important! The pain in this disease begins to intensify with a horizontal position. In adolescents, this disease can be confused with cardiac angina. But you should not panic, because after taking antacids, the pain in the sternum should go away.

The appointment of drugs that reduce the secretion of gastric juice should only gastroenterologist or pediatrician. Self-medication in this matter can only worsen the situation. The doctor prescribes exact dosage drug, taking into account the age of the child and the stage of development of the disease.

Reflux esophagitis in children 1 year old

The principle of the appearance of reflux in children under one year old is based on the underdevelopment of the food sphincter, so food is quickly redirected to reverse side along the esophagus. With age, this area is completely formed, which leads to a decrease in the frequency of regurgitation after feeding.

Scientists have conducted studies that have determined:

These statistics help to understand the frequency and likelihood of developing reflux at this age. If acid reflux has an uncomplicated form, then in infants up to three months a day, at least one regurgitation occurs. When such symptoms do not go away in children after a year, or, on the contrary, it becomes more frequent, then the baby should be shown to the pediatrician.

Symptoms of reflux in one-year-old children:

arching of the back or neck from pain;
fountain vomiting;
slight weight gain
refusal to feed;
crying after and before eating.

If reflux was diagnosed in the early stages, then such a disease can be cured with conservative methods.

Gastroesophageal reflux in children: treatment

If diagnosed with gastroesophageal reflux disease, how to treat and what to do? If the reflux is uncomplicated, then the baby can be cured with a simple change in diet. To do this, doctors recommend taking the following measures:

These are four recommendations that will help the stomach process food faster without irritating the lining of the esophagus. Often parents do not understand how the refusal of milk can affect the development of reflux, because babies under the age of one are still breastfed.

The fact is that milk contains protein, which some children do not digest. This condition is called dietary protein-induced gastroenteropathy.

Important! Often, this disease persists in children under one year old, so nursing mothers need to stop consuming dairy and soy products. If after a year milk protein intolerance persists, then the diet should be extended. In this case, it is better to show the child to the doctor.

Food thickeners

These substances help to make food more dense, so it is easier for the child to get enough faster. Due to the thick consistency, food will not quickly flow from the stomach into the esophagus.

As such substances are used: corn, potato and rice starch, carob flour. American scientists have determined that no more than 1 tablespoon of thickener per 30 ml of liquid can be introduced into the food of a child who is from 0 to 3 months old.

You need to add a thickener to expressed breast milk in the same way, but at the same time, the hole in the bottle needs to be done more so that it is easier for the baby to suck food.

The nuances of the position of the baby's body at the time of feeding

To prevent liquid food from returning from the stomach to the esophagus, you need to feed the baby in an upright position. In addition, after eating, the baby should be carried in her arms so that her head rests on the parent's shoulder. In this position, the child should be in a state of physical and emotional rest. You can not overfeed the baby, as his stomach is still small in volume.

Important! As soon as the baby begins to stubbornly lose interest in food, you need to stop feeding.

If a conservative methods treatments do not help, the doctor may prescribe medication. It is based on drugs that reduce the acidity of gastric juice.

There are four main principles conservative treatment this disease, namely:

healthy and moderate nutrition (eat at least 5 times a day, do not eat 3 hours before bedtime, drink more water, reduce the intake of sweet and fatty foods);
decrease in the production of gastric juice due to the intake of adsorbents and antacids (" Gaviscon»);
taking prokinetics that stimulate the motor-evacuation function of the stomach, (" Cerucal»);
the appointment of drugs that reduce the negative effect of acid on the esophagus (" Ranitidine», « Fanitidin»).

Not always all of these drugs can help the child, because sometimes they can cause side effects. It is contraindicated to give the child these drugs on their own.

Useful video: gastroesophageal reflux disease in children

In what cases is it necessary to urgently contact a pediatrician or gastroenterologist?

If the children of the older age group If you can ask in detail about the features of pain, then children from 1 to 3 years old often cannot tell about their condition.

Parents need to remember a number of symptoms that should alert, namely:

recurring pneumonia in a child;
weight gain or weight loss;
prolonged crying of the baby, which does not stop even after 1-2 hours;
the baby flatly refuses any food and water intake;
fountain regurgitation of food in children under 3 months;
severe irritability in behavior;
blood-streaked stool;
frequent diarrhea;
recurring vomiting.

Such complications are the result of advanced esophageal reflux, so it is better to seek help from pediatrician immediately after the slightest change in the behavior of the child. Of course, we are talking about a persistent change in the baby's appetite, a decrease or stop in weight, frequent vomiting, general weakness of the body.

Gastroesophageal reflux disease in children, the symptoms of which are described above, is a condition that up to a certain age of the child may be the norm.

At timely diagnosis it is possible to cure such inflammation of the esophagus even without medical care. The main thing is to notice changes in the behavior of the baby in time.

Find a free gastroenterologist in your city online:

Gastroesophageal (gastroesophageal) reflux refers to the return of food eaten and stomach acid back into the esophagus. Due to the unformed 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. This results in frequent regurgitation of milk or adapted formula, depending on the type of feeding.

Gastroesophageal reflux is a natural physiological process in infants that promotes the removal of air that has entered the stomach during meals. The small size of the stomach in newborns also leads to regurgitation. The process should not cause concern to parents while the baby's condition is within the normal range.

Causes of Reflux

Physiological reflux in children occurs due to an undeveloped digestive system and lying position baby after eating. Overeating and long-term use of anti-inflammatory drugs by the child only exacerbates the manifestations given state. Symptoms of gastroesophageal reflux are especially painful during active movements, turns and tilts, which is why it is so important to keep calm after eating.

Causes of pathological reflux disease in children include:

congenital anomalies of the digestive system;
entry of bile into the stomach due to deformations of the gallbladder;
hernia of the diaphragm;
the presence of allergies;
lactase deficiency;
premature birth;
damage to the spine in the cervical region.

Types of reflux

According to the degree of complexity, there are:

Uncomplicated reflux is a natural condition for the child's body, passing with age and as the digestive organs form. The frequency of regurgitation with him is 1-4 times a day, the baby is stable in weight and his health does not suffer.
Complicated reflux leading to esophagitis (inflammation of the esophagus) or reflux disease requires treatment. The onset of the disease can be suspected by frequent vomiting, weight loss, refusal to eat, forced position of the back and neck. Pathological gastroesophageal reflux is also manifested by cough in the absence of infections. respiratory tract.

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 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 the rapid development of caries and damage to the teeth.
Cardiovascular disorders: arrhythmia, chest pain 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.
For allergies, exclude proteins from the diet of newborns and nursing mothers cow's milk. 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 the baby stays upright for 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 a 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:

A barium x-ray allows you to analyze the work of the upper part of the 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 gastroesophageal 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.

Pathology of the esophagus in recent years has attracted increased attention of pediatric gastroenterologists and surgeons. This is due to the fact that the reverse reflux (reflux) of the acidic contents of the stomach into the esophagus causes major changes in the mucosa and leads to inflammatory processes different severity(esophagitis). This complicates the course of many diseases, if any. Reflux esophagitis in children significantly impairs the quality of life and causes many problems for parents. Today it is one of the most popular and common diseases of the esophagus.

Anatomy, its role in the development of reflux

Pressure in abdominal cavity much higher than in the chest. Normally, the contents of the stomach cannot enter the esophagus, because the muscular sphincter (pulp, muscle ring) in the lower part of the esophagus, being in a closed state, prevents this. Only a food bolus or liquid can pass when swallowed. The intake of food in the opposite direction normally does not occur due to the tightly compressed esophageal sphincter. Sometimes healthy child there is a short-term reflux: this happens 1-2 times a day, lasts a short time and is considered the norm.

Disease in newborns

Reflux esophagitis in a child occurs due to anatomical structure digestive organs in children.

In infants, the cardial section of the stomach is underdeveloped due to the imperfection of the neuromuscular apparatus, which leads to functional inferiority. This is manifested by frequent regurgitation of air and stomach contents after feeding. Reflux at this age is considered normal, provided that the child develops normally and gains weight. The formation of sphincters begins at four months. By ten months, reflux stops. In the second year of life, the child should not have reflux. Their appearance indicates the pathology of one of the departments of the digestive system.

There is an opinion that reflux in newborns is genetically transmitted: in some families, belching is a common occurrence, in many it is absent or very rare.

Reasons for the development of reflux

In children after a year, reflux develops due to insufficiency of the cardia of the esophagus, when the sphincter of the esophagus gapes partially or completely. This occurs with gastroduodenitis, peptic ulcer disease: due to spasms and hypertonicity of the stomach, intragastric pressure increases and the overall mobility of the digestive tract decreases.

The cause of impaired motor skills can be:

violation of anatomy (hernia of the esophageal opening of the diaphragm, short esophagus, etc.);
violation of the regulation of the esophagus by the autonomic nervous system (stress, motion sickness in transport);
obesity;
diabetes mellitus, when dry mouth and little saliva are concerned: saliva, which has an alkaline reaction, partially “extinguishes” the acidity of the stomach contents that have entered the esophagus and prevents the development of reflux esophagitis;
diseases of the digestive system (gastritis, peptic ulcer stomach).

Factors leading to the development of the disease

The development of reflux esophagitis is facilitated by:

Many foods (chocolate, citrus fruits, tomatoes) that relax the muscles of the esophagogastric junction and cause frequent reflux.
Drugs that have a relaxing effect on the muscles of the esophagus (nitrates, calcium antagonists, aminophylline, some sleeping pills, sedatives, laxatives, hormones, prostaglandins, etc.).
Violation of the diet - overeating or a rare meal in large quantities at the same time, plentiful food before going to bed.

Clinical stages of inflammation of the esophagus

Reflux esophagitis is a pathology that is difficult to recognize in children. The inability to tell complaints, the presence of symptoms that are characteristic not only for reflux esophagitis, but also associated with other organs and systems, the impossibility of a full examination greatly complicates the diagnosis.

The disease proceeds in four stages.

At the first stage, when the inflammatory process in the mucosa is superficial, there are practically no symptoms.
The second stage may be accompanied by the formation of erosions in the mucosa of the esophagus, and then clinically this is manifested by burning behind the sternum, heaviness and pain in the epigastrium after eating, heartburn. Other dyspeptic symptoms that appear with reflux at this stage are belching, hiccups, nausea, vomiting, and difficulty swallowing.
In the third stage, ulcerative lesions of the mucosa occur. This is accompanied by severe symptoms: the child has difficulty swallowing, strong pain and burning behind the sternum, the child refuses to eat.
In the fourth stage, the mucosa is damaged along the entire length of the esophagus, confluent ulcers can form, covering more than 75% of the area, the child's condition is severe, all symptoms are pronounced and constantly disturb, regardless of feeding. This is the most dangerous stage, as it can be complicated by stenosis of the esophagus, the development of oncological diseases.

The disease is detected from the second stage, when characteristic symptoms appear. In the third and fourth stages, surgical treatment is required.

Typical symptoms of reflux esophagitis

Since the onset of reflux and the subsequent development of esophagitis, the child has a variety of symptoms, which are important to notice in time to prevent further severe complications. The most frequent of them:

heartburn - characteristic manifestation reflux. It occurs regardless of food intake and with any physical activity.
Pain, burning in the upper abdomen during or after eating leads to the fact that the child stops eating, becomes restless, whiny. These pains are aggravated by sitting or lying down, with various movements or small physical exertion.
Appears over time bad smell out of the mouth even with healthy teeth. Subsequently, the child's milk teeth are destroyed early.
Growth retardation with frequent regurgitation.

Other manifestations of the disease

Reflux esophagitis, in addition to characteristic symptoms manifested by extraesophageal manifestations. These include: nocturnal cough, reflux otitis, laryngitis, pharyngitis.

According to statistics, 70% of children with this pathology have manifestations of bronchial asthma, which develop due to microaspiration of the contents of the stomach. Late evening heavy feeding can provoke reflux and the development of an asthma attack in a child.

In this regard, it requires close attention:

appeared cough, inflammation of the ear, not associated with infection;
a change in the timbre of the child's voice;
destruction of milk teeth ahead of schedule their shifts;
swallowing disorder;
sudden weight loss;
long-lasting hiccups;
black feces and vomit or traces of blood in them;
change in the child's behavior: aggression or lack of interest in toys;
bowel problems: constipation, diarrhea, flatulence.

Treatment of the disease

Since reflux is considered normal in infants up to a certain age and resolves on its own by 10 months, when the development of the digestive tract is completed, treatment in this age period not required. Only in case of delay physical development, weight loss or lack of weight gain, worrisome symptoms, and behavioral changes, treatment should be initiated.

Compliance with the regime

In both infants and older children, treatment should begin with compliance food regimen. Its rules include:

eating in small portions;
the vertical position of the child for some time after feeding to exclude reflux;
refusal of any physical activity and stress after eating;
early dinner - a few hours before bedtime;
refusal of squeezing tight clothing, belts.

Older children are recommended to use chewing gums for heartburn: their use causes the formation of a large amount of saliva, which has an alkaline reaction and helps to “quench” the acid when gastric contents reflux into the stomach. But with prolonged chewing of gum on an empty stomach for 15-20 minutes, active production of gastric juice occurs, which leads to negative consequences.

Medical treatment

Drug therapy is prescribed by narrow specialists in the initial stages (first and second) with little severe symptoms which can still be corrected by taking medications. Appointments are made after research and taking into account the characteristics of the patient. The following groups of drugs are used:

PPI proton pump inhibitors (omeprazole, pantaprazole) - they block the formation of hydrochloric acid. Omeprazole is the "gold standard" in the treatment of reflux in children from the age of two.
H2 blockers - histamine receptors(Ranitidine, Famotidine) - reduce the acidity of gastric juice, their mechanism of action differs from PPIs, they are not used in children under one year old.
Antacids: the purpose of their use is the neutralization of hydrochloric acid, the restoration of damaged mucosa (Phosphalugel, Maalox, Gaviscon).
Prokinetics (Domperidone, Coordinax, Motilium, Cisapride) - increase the contraction of the muscles of the stomach, increase the tone of the esophageal sphincter, contributing to the fastest emptying of the stomach, reducing reflux.
Enzyme preparations contribute to better digestion of food.
Preparations for combating flatulence (Melikon).

Taking these drugs refers to symptomatic therapy, they do not eliminate the cause of the disease.

With frequent and profuse regurgitation, the child experiences dehydration and a violation of the water and electrolyte balance. In such cases, treatment is carried out in stationary conditions using infusion solutions.

Without exception, all drugs have side effects and contraindications. Therefore, the treatment of a child should be carried out only by a specialist and be fully justified.

Surgery

The third and fourth stages of reflux esophagitis require surgical intervention. Indications for surgical treatment are:

the ineffectiveness of long-term drug treatment (if the treatment lasts several months or years to no avail);
severe pain syndrome, not relieved by drugs;
deep damage to the mucosa (multiple erosions, ulcers), occupying a large extent of the organ;
aspiration syndrome;
severe airway obstruction as a complication of esophagitis.

Compliance with the feeding regimen of the child is the main rule for the prevention of reflux esophagitis. At proper nutrition and timely handling to the pediatrician, if there is the slightest suspicion of a disease of the digestive tract in a child, the development of reflux esophagitis and its severe complications can be avoided.

Gastroesophageal reflux is the back movement of contents from the stomach and duodenum into the esophagus. This process in children is physiological norm if observed 1-2 times a day. Frequent throwing of semi-digested food is a consequence of digestive disorders. Without treatment, such a deviation in children leads to gastroesophageal reflux disease (GERD), an inflammatory process in the esophagus (esophagitis).

Physiological manifestations

The reverse movement of food in infants and infants is a protective reaction to undesirable factors. Sphincters, regulating valves between the gastrointestinal tract, are formed only by 4 months of age. With the help of reflux, the baby's stomach is freed from excess food, air bubbles. The neuromuscular apparatus in children is formed up to a year. Digestive system undergoes changes up to 12-18 months. During this period, the muscles of the organs develop, the necessary enzymes are produced.

Due to the anatomical features, the baby may spit up after each feeding. Reflux up to 10 months is considered normal if the child is gaining weight well and developing dynamically.

The reasons

In children after a year, the reverse movement of food occurs due to imperfections in the cardiac esophagus. The sphincter at the same time closes partially or completely open. This occurs against the background of diseases of the gastrointestinal tract or is associated with provoking factors, anatomical defects.

Gastroesophageal reflux appears in children under one year old as a result of congenital anomalies:

the baby was born prematurely;
oxygen starvation in the womb;
birth injury of the spine;
lactose intolerance;
genetic predisposition;
the use of alcoholic beverages by the mother during gestation;
developmental pathology of the esophageal tube.

These features are a trigger for the development of gastrointestinal diseases. The first deviations are detected in newborns after birth. Children with GERD often spit up and gain weight poorly. After feeding, they vomit in a fountain. Most babies outgrow the disease. With natural development, the angle between the stomach and esophagus increases. The reflux stops.

GERD in children after a year develops with the systematic contact of gastric juice and semi-digested food with the esophageal mucosa. The pH level in the hollow organ is much lower than in other parts of the gastrointestinal tract. As a result of interaction with acidic environment the esophagus is irritated. The inflammatory process begins. Damage to the esophageal mucosa leads to the progression of the disease.

The main causes of gastroesophageal reflux, which provoke insufficiency of the sphincter apparatus in a child, violation motor activity gastrointestinal tract:

insufficient development of the autonomic nervous system;
overweight body;
hiatal hernia;
connective tissue dysplasia.

Disposing factors that lead to retrograde emission:

malnutrition;
early transition to artificial feeding;
increased secretion of gastric juice;
increased intra-abdominal pressure due to constipation, flatulence;
chronic respiratory diseases - bronchial asthma, cystic fibrosis;
food allergy;
infections - herpes, cytomegalovirus;
candidiasis - fungal infection;
gastritis and gastric ulcer, duodenal ulcer;
diabetes;
treatment with drugs that depress the functions of the cardiac department - barbiturates, nitrates, beta-blockers.

GEBR is one of the most common pathologies. According to various sources, its symptoms are observed in 9-17% of children. Most often, the disease is diagnosed between the ages of 5 and 15 years.

Symptoms

Signs of gastroesophageal reflux disease are divided into 2 groups. The first category includes symptoms associated with gastrointestinal dysfunction. The second group includes manifestations of GERD that are not related to the work of digestion.

Signs of reflux in infants:

frequent regurgitation;
growth stop;
slow weight gain;
excessive tearfulness;
recurrent pneumonia;
vomiting (sometimes streaked with blood).

AT rare cases pathology can cause breathing difficulties. This happens if the baby sleeps on his back and begins to choke on the reverse movement of food. If the child spits up no more than 7 times a day, behaves calmly, gains weight well, we are talking about uncomplicated reflux. This form is not considered a disease and does not require any correction.

Uncomplicated reflux becomes a disease at the stage when the acid begins to damage the surface of the esophagus. esophagitis develops. The reverse movement of the contents from the stomach into the esophagus causes pain.

In infants, this is observed:

refusal to eat;
arching of the neck and spine;
frequent crying until blue in the face;
vomiting fountain;
cough not associated with SARS;
stop in weight gain.

After 1.5 years, the sphincters are sufficiently developed to keep food in the stomach. If a child at this age has not stopped episodes of regurgitation, GERD can be suspected. Gastroesophageal reflux may be accompanied by causeless vomiting, excessive thinness, anemia, and emotional instability.

You can check if a child has esophagitis by observing the pillow. When, after sleep, yellow or white spots appear on it, we can talk about a violation of the tone of the sphincters.

In younger children school age and adolescents, the symptoms are pronounced. The disease manifests itself:

(almost in all cases);
belching with a taste of acid or bitterness;
difficulty swallowing food;
increased secretion of the salivary glands;
regular bouts of hiccups;
feeling of a coma behind the sternum while eating;
stool disorders.

Sometimes Clinical signs missing. Changes in the structure of the esophagus are detected by chance, if other diseases are suspected using instrumental diagnostics.

Signs not associated with indigestion that indicate development:

irritability;
insomnia;
bronchial asthma;
paroxysmal cough;
sore throat;
chronic pharyngitis;
frequent otitis;
hoarseness;
feeling of tightness in the neck, chest;
shortness of breath after eating, at night;
erosion on tooth enamel.

Pain and discomfort enhanced in the horizontal position. In adolescents, the disease is sometimes confused with angina pectoris. Throwing acidic contents over time can be complicated by erosions and ulcers on the mucosa of the esophagus.

Classification

GERD can be acute or chronic. During an exacerbation, the symptoms are pronounced. It is difficult for the child to swallow, there is a strong burning sensation in the esophagus, the body temperature rises. At night, salivation increases. The chronic form of reflux esophagitis is manifested in children with systematic discomfort behind the sternum, heartburn, sour or bitter belching.

Depending on the morphological changes in the mucous membrane, esophagitis in children is of two types:

catarrhal form. Inflammation covers the surface of the mucosa. Deep layers are not destroyed.
erosive form. The pain appears during eating, sleeping. The child complains of discomfort throughout the esophagus, burning behind the sternum. In some cases, regurgitation with impurities of blood, mucus may be observed. The reasons erosive esophagitis- chemical burns, complicated infections, long-term use of glucocorticoids (Prednisolone, Dexamethasone), non-steroidal anti-inflammatory drugs (Ketorol, Diclofenac).

If untreated, the erosive form can lead to the formation of ulcers.

According to the type of lesion of the esophagus, gastroesophageal reflux disease can be of several types:

GERD without signs of esophagitis. This stage in children occurs without symptoms, or they are mild.
GERD with esophagitis. Based on the degree of destruction of the walls of the esophagus, the disease proceeds in 4 stages. At the beginning of the process, the inflammation is superficial, the mucosa is loose with areas of hyperemia. The second stage is manifested by the formation of fibrinous plaque in the affected areas. Erosions are found in the folds of the mucosa. In the third stage of erosion spread throughout the esophagus. The fourth degree is characterized by the formation of bleeding ulcers.
GERD caused by impaired motility of the sphincter apparatus. Weakening of functions can be of different severity. The performance of the cardiac department is assessed by the duration of the reflux, the size of the gaping hole during the reverse movement of the contents.

Diagnostics

If gastroesophageal reflux disease is suspected, the pediatrician refers the child to a gastroenterologist. A preliminary diagnosis is made on the basis of complaints from the child or parents. The doctor collects an anamnesis, analyzes predisposing factors, if any.

Diagnosis of GEBR includes instrumental studies and analyzes:

General blood analysis. In the presence of GERD, there is a decrease in the level of hemoglobin, red blood cells. If esophagitis worsens bronchial asthma, in the analysis leukocyte formula shifted to the right.
Short-term or daily pH-metry, which is carried out medical device acidogastrometer. With the help of this study, the level of acidity of gastric juice is determined.
Esophagogastroduodenoscopy (EGDS) - research digestive organs using an endoscope. The procedure is carried out for children of school age. The study allows you to identify the degree of damage and related changes in the gastrointestinal tract.
X-ray with the introduction of a contrast agent to identify the cause of the disease.
Biopsy - analysis of a mucosal sample. The study is carried out to confirm or refute malignant process. A tissue sample is taken during an EGD.

To evaluate motor function esophageal muscles, manometry may be required.

Methods of treatment

The tactics of treating GERD depends on the age of the child and the degree of structural changes in the esophagus. To get rid of the disease, you need an integrated approach.

Elimination of reflux without drugs

In infants and preschoolers, the treatment regimen mainly includes non-drug correction. It includes a change in body position and diet. Infants are fed at an angle of 50-60°. If the child is bottle-fed, pediatricians recommend choosing mixtures with an anti-reflux effect. Such food is produced with the mark "AP". During sleep, the position of the head and upper body should be elevated to avoid reflux.

Mild GERD in school-age children is treated with diet and changes in sleep position. The head end of the bed is raised by 15-20 cm. This measure reduces reflux. In some cases, it helps to eliminate the factors that provoke the reverse movement. food bolus: drug withdrawal causing pathology, decreased physical activity associated with increased intra-abdominal pressure.

If the disease is associated with obesity, weight loss measures are taken. In this case, the child needs to consult an endocrinologist, because. excess weight is usually associated with hormonal disorders.

Medicines

The doctor makes a decision on the appointment of drug therapy taking into account the general condition of the child, the complaints of the parents. The treatment regimen includes drugs:

proton pump inhibitors (PPIs) - Rabeprazole, Pariet;
H2-blockers of histamine - Ranitidine;
prokinetics - Motilium, Motilak;
means regulating the motility of the gastrointestinal tract - Trimebutin, Trimedat;
non-absorbable antacids - Maalox, Lactamil, Gaviscon;
enzymes - Creon, Pancreatin.

The combination of drugs is selected based on the age of the child, the complexity of the disease.

Antacids help when used in combination with other medications. When taken alone, they help relieve heartburn and reflux, but symptoms return after 4-5 hours.

The duration of the course of therapy for surface form esophagitis is 10-14 days. The treatment regimen includes prokinetics and non-absorbable antacids. It will take more time to heal erosions and ulcers, since deep layers of the mucosa are involved in the inflammatory process. Single erosions that do not merge with each other are treated with H2-blockers of histamine receptors and prokinetics for 2-4 weeks. At the discretion of the doctor, the treatment regimen can be supplemented with enzymes, agents that normalize peristalsis. Complicated degrees of esophagitis with confluent ulcers, erosions, persistent vomiting are treated with inhibitors. proton pump, prokinetics. The course of therapy is 1-1.5 months.

The effectiveness of treatment depends on nutrition and lifestyle. If you irritate the esophagus with prohibited foods, recovery may be delayed.

Diet

Correction of nutrition is carried out with any form and degree of esophagitis. Treat gastroesophageal reflux in a child with a special diet.

Basic principles:

you need to eat in small portions 5-6 times a day;
avoid hunger and heavy meals;
meals are taken without haste and at certain hours;
reduce (during the course of therapy exclude) the use of products that cause reflux - coffee, chocolate, carbonated drinks, fats;
limit vegetables with coarse fiber - garlic, fresh onions, radishes, white cabbage;
refuse during the diet from foods that increase acidity - tomatoes, millet, pearl barley, pickles, smoked meats, fast food, kvass;
do not eat 2-3 hours before bedtime;
eat food warm.

Surgical intervention

It is carried out if conservative therapy does not give results or complications arise. Surgery is indicated when GERD is associated with diaphragmatic hernia, severe airway obstruction.

At timely treatment GERD prognosis is favorable. Superficial esophagitis is completely cured. Complicated forms of the disease require systematic monitoring by a specialist.

The information on our website is provided by qualified doctors and is for informational purposes only. Do not self-medicate! Be sure to contact a specialist!

Gastroenterologist, professor, doctor of medical sciences. Prescribes diagnostics and conducts treatment. Study Group Expert inflammatory diseases. Author of more than 300 scientific papers.

As a consequence, they all have gastroesophageal reflux (because vomiting is exactly what it is: throwing stomach contents back up the esophagus). It goes away about a year.

Some children have gastroesophageal reflux disease, a real condition that causes esophagitis or breathing problems. In these cases breast-feeding especially indicated because milk shortens the duration of reflux discharges.

In contrast breast milk, thicker foods (such as anti-reflux mixtures with thickeners) practically do not help against reflux.

What will be discussed?

The fact that sometimes food returns from the stomach through the esophagus back into the baby's mouth. In the first months of a baby's life, this is milk, later - and thick food. In other words, there is a process that is the opposite of natural. Usually the product that you gave the child through the mouth enters the esophagus, from there it descends into the stomach, then follows its way through the intestines, where digestion is completed. But with gastroesophageal reflux, not everything that the child has eaten is thrown back: some of the food is still absorbed and digested.

If a child in the first months of life finds a non-closure of the cardia (the hole that separates the esophagus from the stomach), gastroesophageal reflux is observed especially often, and its manifestations are quite diverse. Sometimes he finds himself with profuse regurgitation, more like vomiting: the child literally begins to whip out of his mouth, as soon as he starts eating, and it happens that some time later after that. And sometimes it is almost invisible outwardly: the returning food reaches only a third or the middle of the esophagus in height, and you can find out that a child has gastroesophageal reflux only by the way he cries from pain caused by penetration into an unprotected from acid esophagus acidic contents of the stomach.

In addition to spitting up, vomiting and crying, gastroesophageal reflux can also be manifested by difficulties experienced by a baby who wants to burp and is unable to do so, or, conversely, in too loud and frequent belching both during feeding and after it.

Finally, sometimes a dry, slightly hoarse cough can serve as a manifestation of reflux. The baby begins to cough immediately after eating or some time after it, mainly when he is placed in a stroller or crib

When is it possible to suspect that a child has gastroesophageal reflux? When a child spits up several times a day or cries bitterly after feeding. And also - when he wakes up a quarter of an hour or half an hour after feeding and begins to cry or burp. In addition, the presence of reflux in a baby can be suspected if he wakes up at night, burps, or even just wakes up often at night, and it is felt that he is experiencing some kind of discomfort. With reflux, the baby often coughs at night, and attacks of dry cough always occur at the same hours.

If a child in the first months of life has bouts of a completely obvious malaise such as lightheadedness, this makes one think that he has gastroesophageal reflux. What are the signs of childhood illness? As a rule, the baby turns pale, stops moving his arms and legs, his eyes seem to stop or become clouded. This type of malaise is very disturbing for parents, who think that this is a manifestation of some very serious illness.

If a lying child begins to cough, and this cough is also accompanied by slight regurgitation, again, you need to check if he has gastroesophageal reflux. The same - in the case of a nocturnal cough.

If in the first months of life the baby regularly wakes up at night with crying, and this happens at 23-24 hours, as well as at 3-4 hours, it is worth considering whether the child has gastroesophageal reflux.

Often repeated otitis, as well as some types of bronchitis, suggest that gastroesophageal reflux is to blame.

Treatment of gastroesophageal reflux

There is no need to treat the child if we are talking about small spitting up, which does not occur constantly, but only occasionally and is well tolerated, without crying. When the baby eats with pleasure, behaves completely normally, he has no disturbances either in digestion or in the duration and quality of sleep, there is nothing to worry about. And vice versa, if the child burps often (especially constantly) and profusely, if there are difficulties with burping, measures should be taken immediately. First of all, you should replace regular milk with condensed milk, which the doctor will recommend to you, and most importantly, keep the child’s upper body elevated: for this, you need to put something under the mattress at the head so that it is 20-30 degrees higher (this will prevent the milk from returning from stomach to mouth). If you have sufficient funds, you can even buy a special anti-reflux mattress that allows the child to sleep in a nearly upright position.

If regurgitation and vomiting are accompanied by crying, do not hesitate for a minute to show the child to the doctor. If the diagnosis of gastroesophageal reflux is confirmed, the pediatrician will advise you not only to raise the head of the mattress, switch to condensed milk and apply a special bandage on the tummy after feeding (thanks to her, the child will not feel pain if acid enters the esophagus from the stomach), but also may prescribe a medicine that will speed up the passage of food through the esophagus to the stomach and on to the intestines. Naturally, all of the above applies to the area symptomatic treatment, because reflux is not a disease, but a consequence of small mechanical anomalies (food, instead of going down, goes up).

There may be another situation that should be considered. Special attention. Imagine a case when symptomatic treatment is not enough to improve the child's condition and return him to normal health, and hence behavior. If the baby, despite all the measures taken, continues to cry, sleeps poorly (or does not sleep at all), you understand that he is in pain. Similar situation makes you think: does the child have inflammation of the esophagus (esophagitis)? Inflammation can be triggered by constant penetration into the esophagus, the walls of which are very delicate and not protected by anything, acidic contents from the stomach.

In this case, the doctor will suggest additional examination to view the inside of the esophagus. This test is called a fibroscopy or endoscopy of the esophagus. It consists in the fact that a special probe is inserted into the esophagus through the mouth, a special device at the end of which allows you to transmit information to the monitor about the condition of the walls of the esophagus. With the help of another very thin probe, acidity in the lumen of the esophagus is examined. The probe, lowered to the level of the stomach, allows you to register acidity rises for several hours or even days. If, as a result of these studies, the diagnosis of inflammation of the esophagus due to reflux is confirmed, then with to a large extent probability, it can be assumed that in the future, therapy will be applied designed to reduce the level of acidity, i.e. reduce negative impact gastric juice to the esophagus.

X-ray examination of the passage of food from the esophagus through the stomach into the duodenum, which is done only after a long ineffective treatment of gastroesophageal reflux, makes it possible to identify a significant anomaly of the entrance to the stomach. In this case, we can talk about a hernia of the esophageal opening of the diaphragm, that is, a hernia located in the region of the upper part of the stomach, which is located in the chest.

Gastroesophageal reflux often disappears with the introduction of complementary foods, when the child's food becomes more varied, or by 6-8 months, when the child begins to feed in a sitting position. But much more often, gastroesophageal reflux disappears only by the end of the first year of a child's life.

If symptoms characteristic of reflux appear in the second year of a baby's life, you should consider whether he has a serious birth defect or a malformation in which part of the stomach is located within the chest. In this case, surgery is most often suggested.

What to Avoid...

To believe that if the baby continues to spit up even when antireflux therapy is already being carried out, then the treatment is ineffective.

Symptomatic treatment is carried out only with the help of bandages and compresses. They reduce the force of acid rising from the stomach on the walls of the esophagus, make it easier for the child to tolerate reflux and accelerate the "unloading" of the stomach. In addition, if the treatment is accompanied by a transition to condensed food, it becomes easier for the baby to swallow food.

It is unnecessary to "heal" a child when the reflux is well tolerated by him and the symptoms are practically absent.

Demand from the doctor that he must prescribe additional studies.

This will not change anything in the development of gastroesophageal reflux, on the contrary, it can only complicate the life of the child, because his condition will become more severe. Indications for additional research may appear only with insufficient effect of therapy, especially if there is pain, cough, etc.

Abruptly stop antireflux treatment (regardless of the opinion of the doctor) when sufficiently serious symptoms are observed.

Assert that the child has gastroesophageal reflux if he vomits all day.

It is possible that this is a manifestation of a completely different disease, so it is best to immediately consult a doctor.

Gastroesophageal reflux is not a disease, but a disruption in the normal mechanical process of food passing through the digestive tract. As a rule, reflux passes (the process of food entering the stomach is getting better) by the end of the first year of a child's life. How soon the reflux will be done away with depends on the severity of this pathology and whether it is associated with some anatomical anomaly.

Usually uncomplicated reflux disappears when a 4-5 month old baby is given a variety of, mostly solid, foods. If at this time the reflux phenomena do not disappear, we can hope that this will happen when the child learns to sit well, that is, by 6-8 months.

Narrowing of the pylorus (pyloric stenosis)

The gatekeeper is the channel through which a portion of food descends from the stomach into the duodenum, at the beginning of the small intestine. Narrowing of the pylorus (medics call this pathology pyloric stenosis) is a thickening of the muscles that “serve” the outlet of the stomach. AT normal condition it allows food to pass from the stomach to the intestine, where it continues to be digested and absorbed, and in a narrowed (stenotic) this transition is difficult.

This malformation (and it is observed mainly in boys, and mainly in too "muscular") is expressed in the fact that the progressive narrowing of the pylorus more and more interferes with the passage of food from the stomach to the intestines, as a result, food stagnates in the stomach, and this causes bouts of vomiting (food goes in the opposite direction).

Symptoms of pyloric narrowing may appear around the 15th day of a child's life, but they appear much more often by the end of the first month: you notice that the child wants to eat, but cannot, because he immediately gives back what he eats, that he loses weight, all the time cries of hunger and suffers from constipation. The baby literally pounces on milk, but after the first sips, vomiting immediately begins.

Diagnosis is made by a physician based on symptoms and is confirmed by abdominal ultrasound (sonography) or x-ray of the digestive tract. Next, surgery is needed. The operation will be simple: a muscle is slightly incised, which ensures the expansion of the gastric outlet to normal sizes.

In childhood, the return of stomach contents into the esophagus (gastroesophageal reflux) can be both the norm and indicate serious illnesses. reflux esophagitis in children various symptoms, noticing which, parents should immediately inform the pediatrician. After diagnostic examination the doctor will reveal cause of GER and, if necessary, prescribe appropriate treatment, talk about preventive measures.

Violation of the secretion of the stomach at an early age is rare, and more often - as a congenital pathology.

Risk factors

The backflow of gastric contents into the esophagus may occur as a result of the following factors:

esophagus of insufficient size;
hiatal hernia;
the use of certain types of drugs;
paralysis of the diaphragm;
malnutrition and abuse of chocolate, alcohol;
excess weight;
disorders of the nervous system;
gastritis and stomach ulcer.

Main symptoms

Reflux esophagitis can cause the following symptoms:

regurgitation observed in baby;
older children may indicate a bitter taste in oral cavity, burning pain in the chest;
anxiety of the baby, manifested in capriciousness, crying;
a delay in the development of the child, which is typical for regular and profuse regurgitation.

On the early stage illness pain begin to disturb immediately after eating. In an infant, reflux is characterized not only by regurgitation, but also by constant vomiting, insufficient weight gain. In addition, parents may notice that the baby poor appetite or its absence at all, a specific smell from the mouth, a cough without signs of diseases of the respiratory system, as well as frequent hiccups, otitis, voice changes and suffocation.

Forms and degrees

A disease such as reflux esophagitis, which occurs in children and adults, has degrees of severity. The first of which is due to the presence of separate erosive formations that do not touch each other. Grade No. 2 is characterized by confluent erosions that do not spread along the top of the mucous membrane layer. The next degree is the third, it is characterized by the formation of confluent ulcers in the lower part of the esophagus. Ulcerative lesions cover the entire surface of the mucous membrane of the body. The last degree is the fourth, which is due to the appearance of stenosis of the esophagus and the formation of a chronic ulcer.

In medical practice, the following forms of GER are distinguished:

Acute. Disease acute form has the following symptoms: fever, pain behind the sternum, difficulty in swallowing food and liquids, belching, burning sensation in the esophagus and increased salivation.
Chronic. In a chronic inflammatory process in the esophagus, breathing difficulties, gagging, hiccups, painful sensation chest and heartburn.

In addition to the two main forms, the disease also has morphological ones. It:

Catarrhal. Inflammatory process It is formed on the surface of the mucous membrane of the organ and does not have a destructive effect on tissues.
Erosive. This form of GER is characterized by deep erosive lesions that have arisen on mucous layer esophagus. With the erosive form of the disease, the following symptoms are present: burning behind the sternum, severe belching, nausea, occasional vomiting and feeling of a foreign object in the throat. This symptomatology with an erosive form of reflux esophagitis, it is more pronounced and gives the patient more discomfort.

GER in newborns

The return of a small amount of food from the stomach into the esophagus in infants up to 3 months is considered normal. This is due to the underdeveloped lower section esophagus, the small size of the stomach and its shape in the form of a ball. Often reflux in babies of the first year of life does not need special treatment and disappears gradually and independently with the introduction of solid foods into the diet.

GER often occurs in infants with the existing failure of the mechanisms responsible for reflux. Cause given deviation serves as autonomic dysfunction due to cerebral hypoxia due to difficult childbirth and unfavorable pregnancy. Often, babies spit up when the mother has a large and fast flow of milk. The child does not have time to swallow it and as a result chokes and spits up. This is more often observed when the nipple is not properly covered by a small mouth, as a result of which air is swallowed.

Reflux of gastric contents and re-swallowing is characteristic of rumination syndrome. This is dangerous because the child may choke on his tongue or fingers. The syndrome occurs in babies from two months to twelve, but there have been cases when rumination was observed in children from six years of age and older. The presence of this syndrome in schoolchildren is due to anxiety, increased nervousness, problems at school or tensions in the family.

When do you need to see a doctor urgently?

Required in urgently consult a pediatrician if the child has difficulty swallowing food, the stool and vomit become black and there are streaks of blood, the body temperature rises sharply and hiccups do not go away for a long time. In addition, it is necessary to urgently visit a doctor if reflux medications are ineffective and the child rapidly begins to lose weight.

Diagnostics

If the symptoms of reflux esophagitis do not go away and increase, it is necessary to conduct a diagnostic examination for the child. Diagnostic methods are x-ray studies, a pH test and esophagogastroduodenoscopy.

X-rays are performed using a contrast agent - barium sulfate, which allows you to see not only the esophagus, but also upper divisions small intestine and stomach. The pH test is carried out using a tube with a small diameter probe. The patient swallows the probe for a day, after which it is removed and the relationship between respiration and reflux is diagnosed. For endoscopy, a long tube is used, at the end of which there is a camera. Thanks to her, the doctor has the opportunity to examine all parts of the gastrointestinal tract.

Methods for the treatment of reflux esophagitis in children

After a diagnostic examination of the baby, the doctor prescribes treatment, which is based on taking medications and observing the necessary diet and lifestyle. In severe cases, surgery may be required.