Earliest sign of pathological gastroesophageal reflux in infants – Paediatrics MCQ

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.

Physiological reflux

  • 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.

Stricture at gastroesophageal junction

Endoscopic image showing stricture at gastroesophageal junction

Investigations

  • Upper GI imaging series
  • Upper GI endoscopy
  • Esophageal pH monitoring

Management

  • 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.

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