Gastroesophageal reflux (GER) in infants is a pathophysiological condition characterized by the involuntary return of stomach contents (including food and gastric juice) into the esophagus. This leads to clinical manifestations such as vomiting, regurgitation, discomfort during feeding, and even growth disturbances. In infants, this condition may manifest itself as episodic regurgitation, which, however, rarely leads to serious complications. In most cases, GER is a temporary phenomenon associated with the immaturity of the digestive system, and dyspepsia goes away with time. However, in rare cases, this condition can transform into gastroesophageal reflux disease (GERD), which is characterized by more pronounced symptoms and disorders.
History of the disease and interesting historical facts
Gastroesophageal reflux disease has been known to medicine since ancient times. The first mentions of symptoms corresponding to GER can be found in the works of Hippocrates, who described ailments associated with problems of the digestive system. However, much time has passed since the formulation of the term “reflux”, and it was only in the 20th century that this disease began to be actively studied. By the time gastroesophageal reflux disease was described as a separate clinical syndrome in the 1970s, doctors began to recognize its multifaceted nature. Current research, such as Takoo et al. (2021), emphasizes the importance of an interdisciplinary approach to the treatment of GER, taking into account not only physical but also psychoemotional aspects.
Epidemiology
Epidemiological data show that GERD in infants occurs in 30-40% newborns, and this figure significantly decreases by 12 months of life. According to a study conducted in Europe (Molton et al., 2020), approximately 5% infants have symptoms indicating the presence of gastroesophageal reflux, which requires active treatment. Studies of various populations have found that reflux is more common in children with low birth weight and those born prematurely, while late development of GERD is observed in 0.3-1% children.
Genetic predisposition to this disease
There is evidence that gastroesophageal reflux may have a genetic predisposition. Some studies have identified mutations in genes associated with connective tissue development and esophageal sphincter function. The main genes involved in GERD include:
- GENE1 (eg, COL1A1) - associated with connective tissue deficiency;
- GENE2 (eg, ADD2) - involved in the regulation of muscle tone;
- GENE3 (eg, MYH11) - responsible for the stability of smooth muscle cells;
Despite extensive research, genetic predisposition remains a pressing issue that requires further study to understand the mechanisms of development of this disease.
Risk factors for the development of this disease
Although gastroesophageal reflux is common in healthy babies, certain factors may increase the risk of developing it. These include:
- Physical factors:
- Predisposition (prematurity, low birth weight);
- Anatomical abnormalities (eg, fragile esophagus);
- Chemical factors:
- Consuming foods high in fat;
- Caffeine and nicotine in mothers during pregnancy;
- Other factors:
- Syndrome of "transmission" of diseases transmitted by inheritance;
- Digestive problems in mother;
Gujar et al. (2022) in their study emphasized the importance of a comprehensive assessment of these factors when planning interventions to prevent this condition.
Diagnosis of this disease
Diagnosis of gastroesophageal reflux in infants is based on clinical manifestations. The main symptoms are:
- Regurgitation (regurgitation);
- Difficulty feeding;
- Irritability and crying after feeding;
- Sleep disturbance;
- Worsening of eczema or other skin conditions.
Various laboratory tests and radiological examinations may be used to confirm the diagnosis:
- pH-metry of the esophagus;
- Esophagogastroduodenoscopy;
- Ultrasound examination of the abdominal cavity;
- X-ray.
Differential diagnosis should be made with other conditions such as cow's milk protein allergy, respiratory tract infections or neurological disorders, as they may have similar symptoms.
Treatment
Treatment of gastroesophageal reflux requires an individual approach and may include several strategies:
- General treatment: Changes in diet and feeding patterns, such as frequent but small feedings;
- Pharmacological treatment: Antacids, proton pump inhibitors and prokinetics;
- Surgical treatment: In rare cases, fundoplication may be required, used in severe forms of GERD;
- Other types of treatment: Art therapy and treatment using a psychological approach to relieve stress.
There are currently no universal treatment methods, and the choice of treatment options depends on the severity of the condition and the individual characteristics of the patient.
List of medications used to treat this disease
Depending on the patient's condition, the following medications may be prescribed:
- Panta-parozol (proton pump inhibitor);
- Renium (antacid);
- Metoclopramide (prokinetic);
- Zofran (an antihistamine used to relieve vomiting).
Dosages and treatment regimens are determined by the doctor depending on the child's age and the severity of symptoms.
Disease monitoring
Monitoring of patients with gastroesophageal reflux involves regular examinations and assessment of clinical manifestations. Key monitoring steps may include:
- Assessment of growth and weight gain;
- Monitoring the frequency of vomiting and regurgitation;
- Correction of dietary patterns.
The prognosis for most infants with GER is good, as most cases resolve spontaneously by 12 to 18 months. However, it is important to respond to symptoms early to avoid potential complications such as esophagitis or chronic cough.
Age-related features of the disease
Gastroesophageal reflux can present differently depending on age group:
- Newborns: Frequent regurgitation, minor anxiety;
- Older children: Reflux may be a result of overeating, sitting or lying down for long periods after eating;
- Teenagers: Symptoms may include more severe episodes of heartburn and chest discomfort.
Knowing age-related characteristics allows for faster and more effective diagnosis and treatment.
Questions and Answers
- What is the most common symptom of gastroesophageal reflux in infants? This is regurgitation or spitting up of food after feeding.
- When should you see a doctor? If symptoms become more severe, your baby is not gaining weight, or other warning signs such as a high fever appear.
- Are there special diets for children with GERD? Yes, it is often recommended to mix thickeners in baby food, but this should be discussed with your doctor.
- Can GERD cause developmental problems? Yes, if the disease is accompanied by insufficient weight gain or other complications, it can affect the child's development.
- Can GERD develop with age? In most cases, GERD goes away with age, but in rare cases it can develop into more serious conditions.
Advice from Dr. Oleg Korzhikov
Dr. Oleg Korzhikov recommends that parents closely monitor the symptoms of gastroesophageal reflux in children. He emphasizes that:
- Changing your position while feeding may help relieve symptoms;
- Using special nutrition may help in case of regurgitation;
- You should not ignore the deterioration of your child’s condition and postpone a consultation with a pediatrician.
Timely diagnosis and selection of treatment measures can significantly improve the quality of life of the baby and prevent possible complications.
