Gastroesophageal Reflux in Children Gerd in Children

375 Pages·2017·8.517 MB·English

Yvan Vandenplas
Editor
Gastroesophageal
Refl ux in Children
GER in Children
123
Gastroesophageal Reflux in Children
Yvan Vandenplas
Editor
Gastroesophageal Reflux
in Children
GER in Children
Editor
Yvan Vandenplas
Universitair Ziekenhuis Brussel
Kidz Health Castle
Brussels
Belgium
ISBN 978-3-319-60677-4 ISBN 978-3-319-60678-1 (eBook)
DOI 10.1007/978-3-319-60678-1
Library of Congress Control Number: 2017951902
© Springer International Publishing AG 2017
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Preface
The diagnosis and management of gastro-oesophageal reflux disease (GERD)
remains a challenge. Each author of this book is a worldwide recognized authority
in different aspects related to GERD. Therefore, we are convinced that this book
will help our readers to better understand the debates about GERD and its diagnosis
and management. Each chapter discusses a different topic or aspect of GERD, going
from basic science to clinical data.
Up to now, such a book has never been written. At the best, there is a chapter on
GERD in a book on GERD focusing on adults in order to highlight the differences
between adults and children (“children are indeed not small adults”), or there is a
chapter on GERD in a textbook of paediatric gastroenterology. We felt that there
was a need for an in-depth book on different aspects of GERD in childhood.
Why is GERD in childhood such a debated topic? The changing spectrum of
symptoms according to age is a major reason. Symptoms are non-specific in infants
and young children. Regurgitation and crying are manifestations of GERD in
infants, but most infants that regurgitate do not have GERD, and many infants that
cry do not suffer from GERD. But when physiologic GER or regurgitation stops and
when it becomes GERD are not clear. In fact, there is a continuum between physi-
ologic reflux and disease. So, parental distress and compliance and the attitude of
the healthcare provider will decide whether an infant is considered to have physio-
logic reflux or (mild) reflux disease. As a consequence, the diagnosis of GERD is
also a matter of controversies. There is no golden standard technique, although 24-h
multiple intraluminal impedance in combination with pH monitoring seems to be
the best, certainly in patients that do not present with overt regurgitation and/or
vomiting. Endoscopy with biopsies is recommended to rule out other diseases than
GERD. If symptoms are non-specific, diagnostic techniques are debated; treatment
is as well discussed. Nutritional treatment seems “on the winning hand” in these
infants with physiologic regurgitation or those with not-severe GERD.
While  anti-acid medication is overused in distressed infants, there is only limited
evidence for its efficacy in young children. Effective and safe medication enhancing
motility and lower oesophageal sphincter function would be welcomed.
The European Society for Paediatric Gastroenterology, Hepatology and Nutrition
(ESPGHAN) and North American Society for Pediatric Gastroenterology,
Hepatology and Nutrition (NASPGHAN) published in 2009 and 2017 common
guidelines on the diagnosis and management of GERD in children. While efforts
v
vi Preface
were made to make these recommendations as much as possible “evidence based”,
it is clear that evidence for many aspects is missing. A summary of the 2017 guide-
lines can be found at the end of this book.
We do hope that this book will help to better understand the actual knowledge
and controversies on GERD in children.
We look forward to a successful and worldwide spreading of this book.
Brussels, Belgium Yvan Vandenplas
Acknowledgements
I am pleased and honoured that so many key opinion leaders contributed to this book.
Thanks to their valuable input, this book will become the reference work on paediat-
ric gastro-oesophageal reflux disease. This is the second book on this topic. The first
one was published in 1992, Oesophageal pH Monitoring for G astro-Oesophageal
Reflux in Infants and Children, and was in fact my PhD thesis. This book was
published 4 years after having obtained my certificate as a paediatrician, and now, in
2017, I am 4 years away from retirement. Thanks to the never-ending support of my
family, it was possible to devote so much time to this passion.
vii
Contents
1 Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Silvia Salvatore and Yvan Vandenplas
2 Pathophysiology of Gastroesophageal Reflux Disease . . . . . . . . . . . . . 15
Samuel Nurko
3 Esophageal Clearance in Gastroesophageal Reflux . . . . . . . . . . . . . . . 27
Maheen Hassan, Frederick W. Woodey, and Hayat Mousa
4 Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Paolo Quitadamo and Annamaria Staiano
5 Diagnosis of Gastroesophageal Reflux Disease . . . . . . . . . . . . . . . . . . 63
Yvan Vandenplas
6 Manometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Taher Omari
7 Multichannel Intraluminal Impedance and pH
Monitoring (pH-MII) in Infants and Children . . . . . . . . . . . . . . . . . . 89
Maartje M.J. Singendonk, F. Jaime, S. Salvatore, M.M. Tabbers,
M.A. Benninga, and Y. Vandenplas
8 G astroesophageal Reflux (GER) in the Preterm Baby . . . . . . . . . . . . 111
Christophe Dupont
9 Gastroesophageal Reflux and the Neurologically
Impaired Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Efstratios Saliakellis and Nikhil Thapar
10 GERD and Dysphagia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Nathalie Rommel and Gigi Veereman
11 Gastroesophageal Reflux and Esophageal Atresia . . . . . . . . . . . . . . . . 147
Frederic Gottrand, Madeleine Gottrand, Rony Sfeir,
and Laurent Michaud
12 GOR(D) and Apnoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Silvia Salvatore and Yvan Vandenplas
ix
x Contents
13 Gastroesophageal Reflux and Respiratory Tract Symptoms . . . . . . . 183
Daniel R. Duncan and Rachel L. Rosen
14 Gastro-oesophageal Reflux and Cow’s Milk Allergy . . . . . . . . . . . . . . 203
Francesco Valitutti, Anna Rybak, and Osvaldo Borrelli
15 Gastroesophageal Reflux and Cystic Fibrosis . . . . . . . . . . . . . . . . . . . 209
Jernej Brecelj
16 G ERD and Eosinophilic Esophagitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Jorge Amil Dias
17 D uodenogastroesophageal Reflux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Ilse Hoffman
18 Gastroesophageal Reflux Disease and Helicobacter
pylori in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Nicolas Kalach
19 The Management of Infant Regurgitation . . . . . . . . . . . . . . . . . . . . . . 269
S. Salvatore, M.M. Tabbers, M.M.J. Singendonk, F. Savino,
A. Staiano, M.A. Benninga, K. Huysentruyt, and Y. Vandenplas
20 GER and Hypnotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
A.M. Vlieger
21 GER and Complementary Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
H.S. van der Heijden and M.M. Tabbers
22 Gastro-oesophageal Reflux and Probiotic . . . . . . . . . . . . . . . . . . . . . . 303
Flavia Indrio and Fernanda Cristofori
23 Gastroesophageal Reflux and Prokinetics . . . . . . . . . . . . . . . . . . . . . . 313
Mário C. Vieira
24 GER and Antacid Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Jose M. Garza and Carlo Di Lorenzo
25 Gastroesophageal Reflux and Surgery . . . . . . . . . . . . . . . . . . . . . . . . . 337
Juan A. Tovar
26 Endoscopic Approaches to the Treatment of GERD . . . . . . . . . . . . . . 367
Mike Thomson
Epidemiology 1
Silvia Salvatore and Yvan Vandenplas
Abstract
Determination of the exact prevalence of gastroesophageal reflux (GER) and
GER disease (GERD) at any age is virtually impossible mainly because symp-
toms are not specific, not all patients seek medical help, many patients are not
(fully) investigated, and prospective data are limited. Many epidemiologic stud-
ies evaluated in infancy the frequency of regurgitation which is a common physi-
ologic symptom in the first months of life with a spontaneous recovery in nearly
all infant. Many other esophageal and extraesophageal symptoms and signs of
GER(D) have been reported, but sensitivity and specificity are low, the causal
relation is uncertain, and there is a lack of diagnostic gold standard technique.
While reflux occurs physiologically at all ages, there is also a continuum between
physiologic GER and GERD leading to different manifestations and complica-
tions depending on individual sensitivity and perception, defense mechanisms,
mucosal resistance, and possible genetic influence. In selected population such
as children with neurological impairment, cystic fibrosis, and esophageal atresia,
severe persisting GER and esophageal complications have been frequently
reported. Whether early treatment of GER(D) significantly changes, the inci-
dence or severity of symptoms and complications in adults is uncertain.
Keywords
Reflux • GER • GERD • Regurgitation • Natural history • Esophagitis • Infants
• Children
S. Salvatore (*)
Department of Paediatrics, Università dell’Insubria, Varese, Italy
e-mail: [email protected]
Y. Vandenplas
Department of Paediatrics, UZ Brussel, Vrije Universiteit Brussels, Brussels, Belgium
© Springer International Publishing AG 2017 1
Y. Vandenplas (ed.), Gastroesophageal Reflux in Children,
DOI 10.1007/978-3-319-60678-1_1