Earliest sign of pathological gastroesophageal reflux in infants is?
A. Upper GI bleeding
B. Respiratory symptoms
C. Oesophageal stricture
D. Postprandial regurgitation
Correct answer : B. Respiratory symptoms
Gastroesophageal reflux in infants
Gastroesophageal reflux in infants can be of 2 types – Physiological or Pathological.
- The infant has regurgitation after feeding, but weight gain is normal.
- There are no respiratory symptoms / features of oesophagitis.
Pathological reflux (gastroesophageal reflux disease)
- Regurgitation is associated with refusal to eat, excessive vomiting, weight loss and failure to thrive.
- The infant has recurrent respiratory features like like wheezing, stridor, chronic cough, aspiration, sore throat, hoarseness and recurrent pneumonitis.
- Features of oesophagitis may be present – upper GI bleeding, anemia and Sandifer syndrome (torticollis and dystonia associated with GERD).
- The most frequent complications are failure to thrive and recurrent respiratory symptoms.
Endoscopic image showing stricture at gastroesophageal junction
- Upper GI imaging series
- Upper GI endoscopy
- Esophageal pH monitoring
- Conservative management
- Small frequent feeds thickened with cereal.
- Burping the infant.
- Hold the infant in an upright position for 20-30 minutes after feeding.
- Medical management
- H2 blockers like ranitidine.
- Proton pump inhibitors like omeprazole and pantoprazole.
- Antacids like magnesium hydroxide.
- Surgical management
- Gastrostomy or fundoplication is done in a very small minority.