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Gastroesophageal Reflux in the First Year of Life

  • Juan A. TovarEmail author
Chapter

Abstract

Gastroesophageal reflux (GER) is a frequent phenomenon in normal toddlers, and only when it causes failure to thrive, esophagitis, recurrent respiratory tract disease, or other symptoms it is designated gastroesophageal reflux disease (GERD). During the first year of life, there is a marked tendency to spontaneous improvement of GER that limits the need for diagnostic tests and therapeutic measures. The present chapter reviews the physiology of anti-reflux mechanisms and why they fail so often in this period of life and the symptoms in babies without concurrent conditions and those in patients with comorbidities like neurologic impairment, respiratory tract disease, previous operations for esophageal atresia/tracheoesophageal fistula/EA/TEF), congenital diaphragmatic hernia (CDH), and anterior abdominal wall defects (AAWD).

Diagnostic tests are not necessary in GER during infancy, and they should be limited in babies with GERD without concurrent diseases in which the tendency toward spontaneous improvement should preside the diagnostic sequence. However, babies with GERD and concurrent diseases require in general pH monitoring, multiple intraluminal impedance measurements coupled with pH monitoring (MII-pH), and, in some particular cases, endoscopy and biopsy of the esophageal mucosa.

Finally, the non-operative and surgical therapeutic tools are summarized, and recommendations for their use in babies without and with concurrent conditions are proposed. It is pointed out that again the tendency of spontaneous improvement of GER at this age should preside all therapeutic attitudes at least in patients without comorbidities in whom the use of medication has many limitations and scarce evidence of efficacy. The indications for surgery, the different anti-reflux operations, including adjuncts like gastrostomy, gastric outlet procedures, or esophagogastric disconnection, and the limitations of these procedures are addressed as well as their complications and results.

Keywords

Gastroesophageal reflux Anti-reflux barrier Mucosal protectors Acid suppression Histamine-2 receptor inhibitors Proton pump inhibitors Prokinetics Fundoplication Nissen Gastrostomy Esophagogastric disconnection 

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Pediatric SurgeryHospital Universitario La PazMadridSpain
  2. 2.Department of PediatricsUniversidad Autonoma de MadridMadridSpain

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