GERD

Resident: Adam J. Bottrill
Date: 26MAR10
Region: Providence
Article title: GERD
Major topic: GERD
Minor topic(s): Erosion

Key points:
1. Define GERD. Chronic symptoms or mucosal damage produced by the abnormal reflux in the esophagus. This is commonly due to transient or permanent changes in the barrier between the esophagus and the stomach. This can be due to incompetence of the lower esophageal sphincter, transient lower esophageal sphincter relaxation, impaired expulsion of gastric reflux from the esophagus, or a hiatal hernia. Respiratory and laryngeal manifestations of GERD are commonly referred to as extra esophageal reflux disease (EERD).
A. GERD may be difficult to detect in infants and children. Symptoms may vary from typical adult symptoms. GERD in children may cause repeated vomiting, effortless spitting up, coughing, and other respiratory problems. Inconsolable crying, failure to gain adequate weight, refusing food, bad breath, and belching or burping are also common. Children may have one symptom or many — no single symptom is universal in all children with GERD.
B. Common symptoms of Pediatric Reflux
* Irritability and pain, sometimes screaming suddenly when asleep. Constant or sudden crying or “colic” like symptoms. Babies can be inconsolable especially when laid down flat.
* Poor sleep habits typically with arching their necks and back during or after feeding
* Excessive possetting or vomiting
* Frequent burping or frequent hiccups
* Excessive dribbling or running nose
* Swallowing problems, gagging and choking
* Frequent ear infections or sinus congestion
* Babies are often very gassy and extremely difficult to “burp” after feeds
* Refusing feeds or frequent feeds for comfort
* Night time coughing, extreme cases of acid reflux can cause apnea and respiratory problems such as asthma, bronchitis and pneumonia if stomach contents are inhaled.
* Bad breath – smelling acidy
* Rancid/acid smelling diapers with loose stool. Bowel movements can be very frequent or babies can be constipated.
2. How does GERD effect the dentition? GERD can effect the dentition through the process of erosion. Almost ALL children with GERD have dental erosions.
3. Can GERD play a role in ECC? It can, however the surfaces effected by GERD are often different than those effected by ECC… this is a disputed fact.
4. What is the medical management? Dietary modification, positional therapy, weight loss, avoid tight garments, Meds (proton pump inhibitors, H2 receptor blockers, antacids), surgery.
5. What is a Nissen fundoplication (w/ or w/out pyloroplasty)? In a fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter: Whenever the stomach contracts, it also closes off the esophagus instead of squeezing stomach acids into it. This prevents the reflux of gastric acid (in GERD). The esophageal hiatus is also narrowed down by sutures to prevent or treat concurrent hiatal hernia, in which the fundus slides up through the enlarged esophageal hiatus of the diaphragm. In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped all the way 360 degrees around the esophagus. Pyloroplasty, a procedure often accompanying fundoplication, is the term that describes the widening of the pylorus. This procedure assists with gastric emptying.










Assessment: Yay GERD.