CRYING BABIES & BEYOND the ins and outs & ups and downs


CHAPTER 6

GASTRO-OESOPHAGEAL REFLUX [GOR]

Reflux is described as ‘a return flow’ and can occur in many parts of the body.

Gastro-oesophageal reflux is defined medically as ‘the involuntary retrograde passage of gastric contents into the oesophagus from the stomach’. In simpler terms this means that stomach contents flow back up the gullet [oesophagus].

Reflux from the stomach into the oesophagus is the most common place in the body for reflux to occur.

In the USA, ‘oesophagus’ is spelled as ‘esophagus’, so gastro-oesophageal reflux [GOR] is referred to as GER.

Illness related to GOR is called gastro-oesophageal reflux disease, abbreviated to GORD, and in the US as GERD. If looking for information on the internet it is helpful to try both spellings as the term  used will depend on where the article was written or where the interest group is based.

Some medical articles refer to laryngopharyngeal reflux [LPR] rather than gastro-oesophageal reflux. This term implies that food comes up to at least the level of the larynx [vocal cords].

Reflux can occur in other parts of the body including from the bladder into the ureters [the draining channels from the kidneys to the bladder] when the muscle mechanism at the end of the ureters doesn’t function properly. This is a cause of urinary tract infection, particularly in children. I suspect that this form of reflux is more common in children who also have GOR, although I do not have figures to confirm this. This form of reflux is called vesico-ureteric reflux [VUR]. ‘Vesico’ refers to the bladder. Because of my suspicion that children with GOR are more likely to have VUR I believe it is important that a urine test should be done for every infant presenting with distressed behaviour. A urine test should also be done whenever a child has a fever for more than 48 hours without obvious cause or whenever the child is irritable or appears unwell without apparent cause. Missing low-grade….


SUMMARY

Gastro oesophageal [GOR] is very common in young infants.

Reflux may be overt [obvious vomiting] or covert [‘silent’ or not obvious vomiting].

Many refluxing babies do not have any problems from their refluxing. The problems are for their parents with the constant smell of vomitus, many marks on the floor and a huge washing load. These babies are often referred to as ‘happy chuckers’.

However some infants do have significant problems from reflux due to acid and enzymes from the stomach irritating other tissues. This is referred to as gastro oesophageal reflux disease [GORD].

The problems that may be caused by reflux include irritation of the lower end of the oesophagus, recurrent chest infections or asthma—related to inhaling acid and enzymes from the stomach. There may be other mechanisms involved also.

Children who reflux and are also atopic [allergic] are more likely to have other problems—particularly in their upper and lower airways. This is because the tissues of atopic people are ‘reactive’ and the irritation may cause swelling and increased mucus production.

The concept that I describe as Eustachian tube Irritation [ETI] is due to the combination of reflux and atopy. Swelling and increased mucus in the back of the nose and throat can cause difficulty with the function of the Eustachian tube and may lead to middle ear problems.

The symptoms of reflux, ‘colic’ and Eustachian tube Irritation [ETI] may have similarities. Distinguishing between the problems is not always easy, especially as these conditions may co-exist. Treatment of all aspects of the child’s problems is important to obtain improvement.

Investigation to diagnose reflux may not be necessary if the symptoms are typical but are needed if the symptoms are not typical. Investigation may be done to decide: whether reflux is present; is causing the child’s symptoms; the frequency and severity of the bouts of reflux; and to assess any damage that may be caused by the reflux.

Managing the reflux may only need simple measures or may need medications. The simple measures and medications are described. Medications may have side effects and treating each child is individual depending on their particular problems and how they respond.

For most refluxing infants there is a ‘light at the end of the tunnel’, with the reflux stopping spontaneously, usually about the time the infant is walking securely.

However some children have a genetic predisposition to have reflux. These children have a strong family history of reflux and the reflux may continue, although usually the symptoms are less severe—and less obvious—than in infancy. The reflux may produce problems for these children [e.g., recurrent sinusitis and asthma], but may not be recognised unless suspected and the child questioned closely or investigated.

There are major emotional problems for the parents [and sometimes siblings] of these infants, as well as the physical needs involved in their care. The parents’ and siblings’ needs should not be overlooked….


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