Abstract
Gastroesophageal reflux disease (GERD) is popularly regarded as a disease of the stomach and esophagus, but it is better understood as a disease of the aerodigestive tract. While human infants universally exhibit gastroesophageal reflux, it becomes a “disease” essentially when the airways are damaged by gastric contents (acid, pepsin, milk, bacteria, bile acids). Meanwhile, positive feedback loops between the organ systems of the chest and abdomen probably exacerbate the disease in vulnerable infants, but also reveal clinical opportunities to interrupt the cycle. While a single diagnostic test for GERD does not exist, surgical amelioration of reflux is very effective protection for the airway. Best results may be achieved not just through the operation but through postoperative nutritional management that incorporates new constraints imposed by fundoplication.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Scherer LD, et al. Influence of “GERD” label on parents’ decision to medicate infants. Pediatrics. 2013;131(5):839–45.
Poets CF, Brockmann PE. Myth: gastroesophageal reflux is a pathological entity in the preterm infant. Semin Fetal Neonatal Med. 2011;16(5):259–63.
Mosby. Mosby’s medical dictionary. 8th ed. St. Louis: Mosby; 2009. p. 312.
Venkatesan NN, Pine HS, Underbrink M. Laryngopharyngeal reflux disease in children. Pediatr Clin North Am. 2013;60(4): 865–78.
Ghosh SK, Kahrilas PJ, Brasseur JG. Liquid in the gastroesophageal segment promotes reflux, but compliance does not: a mathematical modeling study. Am J Physiol Gastrointest Liver Physiol. 2008;295(5):G920–33.
Kawahara H, Dent J, Davidson G. Mechanisms responsible for gastroesophageal reflux in children. Gastroenterology. 1997;113(2): 399–408.
Pandolfino JE, et al. Esophagogastric junction distensibility: a factor contributing to sphincter incompetence. Am J Physiol Gastrointest Liver Physiol. 2002;282(6):G1052–8.
Spitz L, McLeod E. Gastroesophageal reflux. Semin Pediatr Surg. 2003;12(4):237–40.
Popovic ZB, et al. Differences in left ventricular long-axis function from mice to humans follow allometric scaling to ventricular size. J Physiol. 2005;568(Pt 1):255–65.
Muller MJ, et al. Effect of constitution on mass of individual organs and their association with metabolic rate in humans—a detailed view on allometric scaling. PLoS One. 2011;6(7):e22732.
Gounaris A, et al. Gastric emptying of preterm neonates receiving domperidone. Neonatology. 2010;97(1):56–60.
Gounaris A, et al. Theophylline and gastric emptying in very low birthweight neonates: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2004;89(4):F297–9.
Savage VM, Deeds EJ, Fontana W. Sizing up allometric scaling theory. PLoS Comput Biol. 2008;4(9):e1000171.
Vandenplas Y, et al. Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics. 1991;88(4):834–40.
Lopez-Alonso M, et al. Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux. Pediatrics. 2006;118(2):e299–308.
Kamiyama M, et al. Gastroesophageal reflux after repair of congenital diaphragmatic hernia. J Pediatr Surg. 2002;37(12):1681–4.
Kawahara H, et al. Physiological and clinical characteristics of gastroesophageal reflux after congenital diaphragmatic hernia repair. J Pediatr Surg. 2010;45(12):2346–50.
Sigalet DL, et al. Gastroesophageal reflux associated with large diaphragmatic hernias. J Pediatr Surg. 1994;29(9):1262–5.
Pederiva F, et al. Intrinsic esophageal innervation in esophageal atresia without fistula. Pediatr Surg Int. 2008;24(1):95–100.
Tsai J, Blinman TA, Collins JL, Laje P, Hedrick HL, Adzick NS, Flake AW. The contribution of hiatal hernia to severe gastroesophageal reflux disease in patients with gastroschisis. J Pediatr Surg. 2014;49(3):395–8.
Santos MM, Tannuri U, Maksoud JG. Alterations of enteric nerve plexus in experimental gastroschisis: is there a delay in the maturation? J Pediatr Surg. 2003;38(10):1506–11.
Bardhan KD, Strugala V, Dettmar PW. Reflux revisited: advancing the role of pepsin. Int J Otolaryngol. 2012;2012:646901.
Abu Jawdeh EG, Martin RJ. Neonatal apnea and gastroesophageal reflux (GER): is there a problem? Early Hum Dev. 2013;89 Suppl 1:S14–6.
Dettmar PW, et al. Review article: reflux and its consequences - the laryngeal, pulmonary and oesophageal manifestations. Conference held in conjunction with the 9th International Symposium on Human Pepsin (ISHP) Kingston-upon-Hull, UK, 21-23 April 2010. Aliment Pharmacol Ther. 2011;33:1–71.
Macharia EW. Comparison of upper gastrointestinal contrast studies and pH/impedance tests for the diagnosis of childhood gastro-oesophageal reflux. Pediatr Radiol. 2012;42(8):946–51.
Chung C, et al. Simultaneous correction of malrotation and gastroesophageal reflux in infants. Am Surg. 1996;62(10):800–2.
Tiboni SG, et al. Management of gastroesophageal reflux associated with malrotation in children. J Pediatr Surg. 2011;46(2):289–91.
Valusek PA, et al. Does an upper gastrointestinal study change operative management for gastroesophageal reflux? J Pediatr Surg. 2010;45(6):1169–72.
Kashyap R, et al. Evaluation of radionuclide gastroesophagography as a suitable screening test for detection of gastroesophageal reflux. Indian Pediatr. 1993;30(5):625–8.
Morigeri C, et al. Radionuclide scintigraphy in the evaluation of gastroesophageal reflux in symptomatic and asymptomatic pre-term infants. Eur J Nucl Med Mol Imaging. 2008;35(9):1659–65.
Johnson DG, et al. Are scintiscans accurate in the selection of reflux patients for pyloroplasty? J Pediatr Surg. 1998;33(4):573–9.
Rosen R, et al. Lipid-laden macrophage index is not an indicator of gastroesophageal reflux-related respiratory disease in children. Pediatrics. 2008;121(4):e879–84.
Njere I, Stanton M, Davenport M. Identification of pepsin in bronchoalveolar fluid (BAL) as a new test for the detection of pulmonary aspiration associated with gastroesophageal reflux. J Pediatr Surg. 2006;41(10):1787; author reply 1787–8.
Duan N, Kravitz RL, Schmid CH. Single-patient (n-of-1) trials: a pragmatic clinical decision methodology for patient-centered comparative effectiveness research. J Clin Epidemiol. 2013;66(8 Suppl):S21–8.
Holbrook JT, et al. Lansoprazole for children with poorly controlled asthma: a randomized controlled trial. JAMA. 2012;307(4):373–81.
van der Pol RJ, et al. Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics. 2011;127(5):925–35.
Terrin G, et al. Ranitidine is associated with infections, necrotizing enterocolitis, and fatal outcome in newborns. Pediatrics. 2012; 129(1):e40–5.
Hibbs AM, Lorch SA. Metoclopramide for the treatment of gastroesophageal reflux disease in infants: a systematic review. Pediatrics. 2006;118(2):746–52.
Corvaglia L, et al. Pharmacological therapy of gastroesophageal reflux in preterm infants. Gastroenterol Res Pract. 2013;2013: 714564.
Levi P, et al. Bethanechol versus antiacids in the treatment of gastroesophageal reflux. Helv Paediatr Acta. 1985;40(5):349–59.
Lamian V, et al. Characterization of agonist-induced motilin receptor trafficking and its implications for tachyphylaxis. Mol Pharmacol. 2006;69(1):109–18.
Almeida MB, et al. Adequacy of human milk viscosity to respond to infants with dysphagia: experimental study. J Appl Oral Sci. 2011;19(6):554–9.
Sevenhuysen GP, Holodinsky C, Dawes C. Development of salivary alpha-amylase in infants from birth to 5 months. Am J Clin Nutr. 1984;39(4):584–8.
Zhu Y, Hsu WH, Hollis JH. The impact of food viscosity on eating rate, subjective appetite, glycemic response and gastric emptying rate. PLoS One. 2013;8(6):e67482.
Sanaka M, et al. Effects of agar and pectin on gastric emptying and post-prandial glycaemic profiles in healthy human volunteers. Clin Exp Pharmacol Physiol. 2007;34(11):1151–5.
Miyazawa R, et al. Effects of pectin liquid on gastroesophageal reflux disease in children with cerebral palsy. BMC Gastroenterol. 2008;8:11.
Huang RC, Forbes DA, Davies MW. Feed thickener for newborn infants with gastro-oesophageal reflux. Cochrane Database Syst Rev. 2002;(3):CD003211.
Corvaglia L, et al. A thickened formula does not reduce apneas related to gastroesophageal reflux in preterm infants. Neonatology. 2013;103(2):98–102.
Rothenberg SS. The first decade’s experience with laparoscopic Nissen fundoplication in infants and children. J Pediatr Surg. 2005;40(1):142–6; discussion 147.
Rothenberg SS. Two decades of experience with laparoscopic nissen fundoplication in infants and children: a critical evaluation of indications, technique, and results. J Laparoendosc Adv Surg Tech A. 2013;23(9):791–4.
Broeders JA, et al. Objective outcomes 14 years after laparoscopic anterior 180-degree partial versus nissen fundoplication: results from a randomized trial. Ann Surg. 2013;258(2):233–9.
Broeders JA, et al. Laparoscopic anterior versus posterior fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials. Ann Surg. 2011; 254(1):39–47.
Broeders JA, et al. Laparoscopic anterior 180-degree versus nissen fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials. Ann Surg. 2013;257(5):850–9.
Broeders JA, et al. Five-year outcome after laparoscopic anterior partial versus Nissen fundoplication: four randomized trials. Ann Surg. 2012;255(4):637–42.
Rothenberg SS, Bratton D. The effects of laparoscopic Nissen fundoplication to enhance pulmonary function in the treatment of a patient with severe asthma and gastroesophageal reflux disease. J Allergy Clin Immunol. 2008;121(4):1069–70.
Macharia EW, et al. Fundoplication in ventilator-dependent infants with gastro-oesophageal reflux. Eur J Pediatr Surg. 2012;22(1):91–6.
Rothenberg SS, et al. Laparoscopic fundoplication to enhance pulmonary function in children with severe reactive airway disease and gastroesophageal reflux disease. Surg Endosc. 1997;11(11):1088–90.
St Peter SD, et al. Minimal vs extensive esophageal mobilization during laparoscopic fundoplication: a prospective randomized trial. J Pediatr Surg. 2012;46(1):163–8.
Ngerncham M, et al. Risk factors for recurrent gastroesophageal reflux disease after fundoplication in pediatric patients: a case-control study. J Pediatr Surg. 2007;42(9):1478–85.
Osborne MP, et al. Rotavirus-induced changes in the microcirculation of intestinal villi of neonatal mice in relation to the induction and persistence of diarrhea. J Pediatr Gastroenterol Nutr. 1991;12(1):111–20.
Fossmark R, et al. Rebound acid hypersecretion after long-term inhibition of gastric acid secretion. Aliment Pharmacol Ther. 2005;21(2):149–54.
Fossmark R, Waldum H. Rebound acid hypersecretion. Aliment Pharmacol Ther. 2007;25(8):999–1000; author reply 1000.
Waldum HL, et al. Rebound acid hypersecretion from a physiological, pathophysiological and clinical viewpoint. Scand J Gastroenterol. 2010;45(4):389–94.
Calabria AC, et al. Postoperative surveillance and detection of postprandial hypoglycemia after fundoplasty in children. J Pediatr. 2011;159(4):597–601.e1.
Cook R, Blinman T. The case of the wretched retcher. ICAN. 2009;1(2):94–7.
Ashcraft KW, et al. Thal fundoplication: a simple and safe operative treatment for gastroesophageal reflux. J Pediatr Surg. 1978;13(6D):643–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media New York
About this chapter
Cite this chapter
Blinman, T. (2015). Gastroesophageal Reflux and the Neonatal Airway. In: Lioy, J., Sobol, S. (eds) Disorders of the Neonatal Airway. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1610-8_26
Download citation
DOI: https://doi.org/10.1007/978-1-4939-1610-8_26
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-1609-2
Online ISBN: 978-1-4939-1610-8
eBook Packages: MedicineMedicine (R0)