1. GASTROESOPHAGEAL REFLUX
NGWATU P
PAEDIATRIC GASTROENTEROLOGIST

2. LPR
the retrograde flow of stomach content to the larynx and pharynx whereby this material comes in contact with the upper aerodigestive tract.
is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness.
The most common laryngoscopic signs are redness and swelling of the throat

3. physiological barriers to LPR
LES
ESOPHAGEAL CLEARANCE influenced by esophageal peristalsis, saliva and gravity,
and
the UES.
stomach content comes in contact with the laryngopharyngeal tissue, causing damage to the epithelium, ciliary dysfunction, inflammation, and altered sensitivity

4. GER
the passage of gastric contents into the esophagus with or without regurgitation and/or vomiting.
GERD
symptoms of infant GERD vary widely and may include excessive crying, back arching, regurgitation and irritability.
Many of these symptoms, however, occur in all babies with or without GERD, making a definitive diagnosis challenging.

5. Non acid reflux
Nonacid reflux has been associated with inflammation in both LPR and GERD
The reflux of duodenal-gastric juices contains bile acids and pancreatic secretions and can reach the larynx
pepsin is actively transported into laryngeal epithelial cells and remains stable at pH 7.4, but is irreversibly inactivated at pH 8. After pepsin is reactivated by a decline from pH 7.4 to pH 3, 72% of peptic activity remains.

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7. history
The history should include the age of onset of symptoms, a thorough feeding and dietary history (e.g. length of feeding period, volume of each feed, type of formula, quality of milk supply when breast feeding, methods of mixing the formula, size of the feeds, additives to the feeds, restriction of allergens, time interval between feeding), the pattern of regurgitation/spitting/vomiting (e.g. nocturnal, immediately post prandial, long after meals, digested versus undigested), a family medical history, possible environmental triggers (including family psychosocial history and factors such as tobacco use and second-hand tobacco smoke-exposure), the patient’s growth trajectory, prior pharmacologic and dietary interventions and the presence of warning signs

8. Endoscopy and Biopsy
EGD has three roles in the evaluation of symptomatic children: to diagnose erosive esophagitis, to diagnose microscopic esophagitis, and to diagnose other conditions mimicking GERD.
GERD may be present despite normal endoscopic appearance of the esophageal mucosa as well as in the absence of histological abnormalities

9. Barium Contrast Radiography (Upper GI Series)
Not useful for the diagnosis of GERD
reflux events can be detected in as many as 50% of children undergoing radiologic imaging, regardless of symptoms
Useful for the diagnosis of upper gastrointestinal tract anatomic abnormalities such as esophageal stricture, hiatal hernia, intestinal mal-rotation, achalasia, tof, pyloric stenosis

10. Nuclear Scintigraphy
May have a role in patients with chronic or refractory respiratory symptoms, to diagnose
pulmonary aspiration of refluxed gastric contents
Not routinely recommended in patients with other potentially reflux-related symptoms

11. Prokinetics
The potential benefits (i.e. reduction of reflux- related symptoms, in particular, regurgitation or vomiting) of currently available prokinetic agents are outweighed by their potential side effects
There is insufficient evidence to support the routine use of metoclopramide,erythromycin, bethanechol or domperidone for GERD

12. buffering agents
chronic therapy with alginates and sucralfate is not recommended for GERD

13. microbiome
pre-and probiotics have not been adequately studied and may pose more risk and cost so therefore cannot be recommended for the reduction of symptoms of GERD in infants and children.

14. Surgery
Should be considered only in children with an established diagnosis of GERD and failure of optimized medical therapy; or
long-term dependence on medical therapy

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