Gastroesophageal reflux disease in children

Gastroesophageal reflux disease in children is a chronic recurrent disease characterized by cases of pathological reflux of stomach contents into the esophagus, regardless of whether morphological changes in the esophagus occur or not. In most patients, as a result of frequent reflux, the esophageal mucosa becomes inflamed, and reflux esophagitis develops.

ICD-10 code

K21.0. Gastroesophageal reflux disease.

Epidemiology of gastroesophageal reflux disease in children

The true incidence of gastroesophageal reflux disease in children is unknown. The incidence of reflux esophagitis in children with gastrointestinal diseases is, according to various authors, 8.7-17%.

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Symptoms of gastroesophageal reflux disease in children

In the structure of clinical symptoms of gastroesophageal reflux disease in children, esophageal and extraesophageal symptoms are distinguished.

Esophageal symptoms include heartburn, regurgitation, the "wet spot on the pillow" symptom, belching (air, sour, bitter), periodic chest pain, pain or discomfort when food passes through the esophagus (odynophagia), and dysphagia. The severity of these symptoms in children is determined primarily by the state of the motor function of the lower esophageal sphincter, rather than the morphological state of the esophageal mucosa.

Symptoms of Gastroesophageal Reflux Disease in Children

Classification of gastroesophageal reflux disease

There is no unified classification of gastroesophageal reflux disease in children. Below is the working classification of Privorotsky V.F. and Luppova N.E. (2006).

1. The severity of gastroesophageal reflux (based on the results of endoscopic examination):
   • without esophagitis;
   • with esophagitis (I-IV degrees). The degree of motor disturbances in the esophagogastric junction zone (A, B, C).
2. The severity of gastroesophageal reflux (based on the results of an X-ray examination):
   • gastroesophageal reflux grades I-IV, sliding hernia of the esophageal opening of the diaphragm.
3. Severity of clinical symptoms:
   • light;
   • average;
   • heavy.
4. H. pylori infection:
   • HP(+);
   • HP(-).
5. Extraesophageal signs of gastroesophageal reflux disease:
   • bronchopulmonary;
   • otolaryngological;
   • cardiological;
   • Dental.
6. Complications of gastroesophageal reflux disease:
   • Barrett's esophagus;
   • esophageal stricture;
   • posthemorrhagic anemia.

Causes and pathogenesis of gastroesophageal reflux disease in children

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Diagnosis of gastroesophageal reflux disease

After a survey image of the chest and abdominal cavities, the esophagus and stomach are examined standing with barium in direct and lateral projections, in the Trendelenburg position with slight compression of the abdominal cavity. The patency and diameter of the esophagus, the relief of the mucous membrane, and the nature of peristalsis are assessed. Gastroesophageal reflux disease is characterized by a reverse flow of contrast from the stomach into the esophagus.

Diagnosis of gastroesophageal reflux disease in children

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Treatment of gastroesophageal reflux disease in children

Treatment for gastroesophageal reflux disease consists of 3 components:

1. a complex of non-drug interventions, primarily normalization of lifestyle, daily routine and nutrition;
2. conservative therapy;
3. surgical correction.

How is gastroesophageal reflux disease treated in children?