Gastroesophageal reflux in children

374 Pages·2022·8.001 MB·English

by  Yvan Vandenplas (editor)

Gastroesophageal
Reflux in Children
Yvan Vandenplas
Editor
Second Edition
123
Gastroesophageal Reflux in Children

Yvan Vandenplas
Editor
Gastroesophageal Reflux
in Children
Second Edition
Editor
Yvan Vandenplas
Vrije Universitiet Brussel (VUB)
UZ Brussel
KidZ Health Castle
Brussels, Belgium
ISBN 978-3-030-99066-4 ISBN 978-3-030-99067-1 (eBook)
https://doi.org/10.1007/978-3-030-99067-1
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland
AG 2017, 2022
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Introduction
Dear reader,
Thank you for reading this book on gastroesophageal reflux (disease) in children.
This second edition was made possible thanks to the success of the first edition. The
second edition was extensively revised but still provides a comprehensive overview
of almost all aspects of Gastroesophageal Reflux (Disease) in children. There are
chapters on the epidemiology and pathophysiology of the condition. Multiple diag-
nostic methods and treatment techniques are also covered. Profoundly revised chap-
ters discuss several aspects associated with GER in defined patient populations. The
chapters on diagnosis and management are also extensively updated. New chapters
cover new knowledge on the microbiome, how nutrition can be key to treatment.
Much attention is also given to adverse effects of medical treatment. Attention is
also given to colic and new developments in eosinophilic esophagitis are also
described. GER in preterm infants, neurologic patients, and children with cystic
fibrosis is discussed as well. An important part of the book is dedicated to therapeu-
tic approaches from medication to surgery and alternative approaches such as com-
plementary medicine and hypnotherapy.
This Second Edition on Gastroesophageal Reflux in Children was made possible
thanks to all co-authors who realized outstanding contributions. Without their tre-
mendous work, this book would not have been possible. Thanks to their work, this
book offers you an up-to-date overview of all aspects of Gastroesophageal Reflux
disease in children. This book has the intention to be a critical resource for pediatri-
cians, gastroenterologists to pulmonologists, otolaryngologists, and neurologists
Me and all co-authors do hope that you will enjoy the content of our book.
Yvan Vandenplas
v
Contents
1 Epidemiology of GER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Silvia Salvatore and Yvan Vandenplas
2 Pathophysiology of GER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Samuel Nurko
3 Symptoms of GER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Paolo Quitadamo and Annamaria Staiano
4 Dysphagia and GER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Valeria Dipasquale and Claudio Romano
5 Duodeno-GER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Ilse Hoffman
6 GER in Preterm Infants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Francesco Cresi, Domenico Umberto De Rose, and Elena Maggiora
7 GER and Respiratory Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Valeria Dipasquale and Claudio Romano
8 GER and Apnea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Silvia Salvatore and Yvan Vandenplas
9 GER in Cystic Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Frederick W. Woodley, Rosara Bass, Don Hayes Jr, and
Benjamin T. Kopp
10 GER and Esophageal Atresia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Frederic Gottrand, Audrey Nicolas, Rony Sfeir, and
Madeleine Aumar
11 GERD and Cow’s Milk Allergy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Rosan Meyer
12 GER and Overweight/Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Karolien Van De Maele
13 GER and Eosinophilic Esophagitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Jorge Amil Dias
vii
viii Contents
14 GER and Helicobacter pylori . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Oya Yücel
15 GER and Probiotic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Flavia Indrio and Fernanda Cristofori
16 Diagnosis of GERD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Michiel van Wijk
17 Contribution of Histology to the Diagnosis of GER. . . . . . . . . . . . . . . . 217
Chloé Girard and Christophe Faure
18 How to Position pH-Impedance Probes in Pediatric Patients . . . . . . . . 229
Yvan Vandenplas, Kris Van De Maele, Caroline Ernst, Astrid Leus,
and Koen Huysentruyt
19 Esophageal Clearance in GERD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Stefano Nobile and Giovanni Vento
20 Manometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Taher Omari
21 Nuclear Scintigraphy and GER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Yvan Vandenplas and Bruno Hauser
22 Acid-Lowering Drugs for the Treatment of Gastro-esophageal
Reflux Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Carmelo Scarpignato
23 Anti-Acid Drugs: Adverse Effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Elvira Ingrid Levy, Sebastien Kindt, Melina Simon, and Yvan
Vandenplas
24 GER and Prokinetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Mário C. Vieira
25 Adverse Effects of GER Medication Except Anti-Acid Drugs . . . . . . . 327
Melina Simon, Elvira Ingrid Levy, and Yvan Vandenplas
26 GER and Hypnotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
A. M. Vlieger
27 Alternative Medicine and Lifestyle Changes in GERD . . . . . . . . . . . . . 339
Yvan Vandenplas
28 GERD and Endoscopic Therapeutic Approach . . . . . . . . . . . . . . . . . . . 345
Shishu Sharma and Mike Thomson
29 Surgical Options to Treat GERD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Antoine De Backer
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Epidemiology of GER 1
Silvia Salvatore and Yvan Vandenplas
Abstract
The real prevalence of gastro-esophagel reflux (GER) and GER-disease (GERD)
is difficult to estimate, particularly in infants and young children, because of
caregiver’s interpretation, lack of specific symptoms, proper investigation and a
gold standard test, over-the-counter medications, and limited prospective stud-
ies. GER episodes may physiologically happen several times per day, especially
in postprandial period, without causing any manifestations. In many reports, the
terms GER and GERD, that is GER with troublesome symptoms or complica-
tions, are often erroneously interchangeably used, hampering the confusion
about the real prevalence of these two different conditions. Regurgitation is a
common manifestation of GER, occurring in at least 25% of infants, naturally
disappearing before the first year of life and representing a functional disorder in
the vast majority of cases. Despite it being neither sufficient nor specific, regur-
gitation is often considered a reliable symptom for the diagnosis of
GERD. Conversely, heartburn shows an adequate specificity for GERD in older
children and adolescents although sensitivity is poor particularly for extra-
esophageal manifestations. Few studies assessed the prevalence of GERD per-
forming upper endoscopy and esophageal pH-impedance and even in these
studies, recruitment and diagnostic criteria are heterogeneous. Prospective data
off and on GER treatment are also limited in pediatric ages and the rate of pro-
gression from GER to GERD is still unclear.
S. Salvatore (*)
Pediatric Department, Hospital “F. Del Ponte”, University of Insubria, Varese, Italy
e-mail: [email protected]
Y. Vandenplas
Vrije Universitiet Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
© The Author(s), under exclusive license to Springer Nature 1
Switzerland AG 2022
Y. Vandenplas (ed.), Gastroesophageal Reflux in Children,
https://doi.org/10.1007/978-3-030-99067-1_1
2 S. Salvatore and Y. Vandenplas
Nevertheless, a number of studies demonstrated an increased prevalence of
GERD in children with neurological impairment, cystic fibrosis, and esophageal
atresia. However, individual sensitivity, esophageal clearance, and mucosal
resistance determine the severity of symptoms and the presence of
complications.
Keywords
Reflux · GER · GERD · Regurgitation · Natural history · Esophagitis · Infants
Children
Introduction
The exact prevalence of gastroesophageal reflux (GER) and GER-disease (GERD)
which is defined as GER causing troublesome symptoms or complications [1] is
unclear in all pediatric ages. The caregiver’s interpretation of symptoms, the lack of
a specific manifestation of GERD, the complementary diagnostic role of upper
endoscopy and esophageal pH-impedance (pH-MII) with no gold standard test, the
limited investigations performed in young children, the high heterogeneity of the
literature data and the over-the-counter medications determine the difficulty in the
epidemiological estimation.
Epidemiological Pitfalls
GER, that is the return of gastric contents into the esophagus, physiologically occurs
several times per day in every individual, particularly in postprandial periods and in
the first months of life [1–3]. Most reflux episodes are brief and do not cause any
manifestation. Regurgitation is the involuntary and effortless progression of GER
into and eventually outside the oral cavity [1] and has a peak incidence at 3–4 months
of life occurring in more than 25% of healthy infants. The spectrum of GERD pre-
sentation is wide and unspecific, including gastrointestinal (regurgitation, vomiting,
heartburn, and epigastric pain), respiratory and general (feeding and sleeping prob-
lems, crying, irritability, failure to thrive) symptoms. Because these manifestations
are age-related and overlap many other functional and organic conditions, the preva-
lence of GERD cannot accurately rely on a clinical diagnosis except in the case of
heartburn that is considered a highly sensitive and specific symptom [1, 4].
Moreover, none of the above symptoms is predictive of esophagitis but only a
minority of children are submitted to upper endoscopy and esophageal biopsies.
An impaired quality of life is sufficient to make the passage from GER to GERD
in adults but is difficult to report in childhood because it is mainly related to parental
perception.
The absence of a gold standard test for the diagnosis of GERD, the limited inves-
tigations in infants and children, the heterogeneity of diagnostic criteria used in
different studies and the lack of large prospective trials hamper the difficulty to
clarify the prevalence of GERD.