GASTROESOPHAGEAL REFLUX

Suzanne Rubin

Overview

Gastroesophageal reflux (GER) refers to uncomplicated, recurrent spitting and vomiting in healthy infants that resolves without intervention. It is considered physiologic and usually resolves before 12 months of life. GER occurs commonly in healthy infants and is a frequent area of discussion with pediatricians, especially during the first several months of life. Symptoms include frequent nonbilious “spit up” after feedings that does not seem to cause problems. Weight gain, attainment of developmental milestones, and general contentment are noted. Clinical interventions for parents at this stage involve education and reassurance that resolution is likely by 12 months of life. Gastroesophageal reflux disease (GERD) is a more complicated, pathological form of reflux that causes alarming symptoms or leads to medical complications and may occur at any age. The esophageal manifestations of GERD can include heartburn, frequent regurgitation, and mucosal injury of the esophagus.

Background

Historical literature search shows a relative lack of reference to this disease process before the mid-19th century. Most likely this represents a lack of anatomical understanding of the disease process and identification. How and where the reflux condition initiated was not well understood before the invention of the rigid endoscopy and the first barium upper gastrointestinal radiologic studies in the 1960s (Modlin, Kidd, & Lye, 2003). At this time, major access to the esophageal lumen was developed and the understanding of anatomy and physiology began. Following use of this procedure, the development of pressure manometers and pH probes helped to document the relationship of acid secretion as well as esophageal–gastric structure, physiology, and pathology. Understanding normal maturational changes in the infants’ stomach and esophagus contributed to a better understanding of these processes. The association of infants with colic, feeding disorders, and regurgitation followed. Increasing awareness has permitted the development of additional diagnostic studies and treatment. GER is common in infants and usually is not pathological (Martin & Hibbs, 2016).

Clinical Aspects

GER is common in infants with regurgitation present in 50% to 70% of all infants, peaking at age 4 to 6 months, and typically resolving by 1 year. A small minority of infants with GER develop other symptoms suggestive of GERD, including irritability, feeding refusal, hematemesis, anemia, respiratory symptoms, and failure to thrive (Martin & Hibbs, 2016).

145ASSESSMENT

Premature infants are at increased risk when compared to full-term infants for GER because of immaturity of feeding skills as well as immature or impaired anatomic and physiologic factors that limit reflux (e.g., transient relaxation of the lower esophageal sphincter). GER is more common in healthy preterm infants where gastric fluids reflux into the esophagus as often as 30 or more times daily (Martin & Hibbs, 2016). Nursing assessment includes close monitoring of growth parameters, feeding and vomiting history, history of irritability, and other findings that may be related to pathologic reflux.

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