What is Heartburn (GERD) in children?
Heartburn is known in the scientific literature as gastroesophageal reflux disease (GERD), a chronic disease that relapses and is characterized by morphological changes in the mucous membrane of the esophagus due to retrograde reflux of the gastric or gastrointestinal contents and various symptoms associated with the esophagus.
According to the severity of gastroesophageal reflux heartburn (GERD) in children it happens:
- without esophagitis;
- with esophagitis (I — IV degrees).
According to the severity of symptoms (severity):
- light
- moderate
- heavy.
Extra-esophageal symptoms of heartburn (GERD) are divided into such types:
- cardiac;
- bronchopulmonary;
- otorhinolaryngological;
- dental.
There are such complications of heartburn in children:
- esophageal stricture
- Barrett’s esophagus
- posthemorrhagic anemia.
Causes of Heartburn (GERD) in Children
Among the predisposing factors are the following:
- male gender (in girls, heartburn is less common),
- senior school age (younger children are less susceptible to GERD),
- burdened heredity for gastrointestinal diseases,
- vegetative dysregulation,
- organic pathology of the gastroduodenal zone,
- the presence of foci of chronic infection,
- parasitic parasitic infestation,
- mesenchymal insufficiency,
- the presence of foci of chronic infection,
- sliding hernia of the esophageal opening of the diaphragm, etc.
Among the provoking factors, the following are distinguished:
- Constipation
- Violation of diet
- Poor food
- Long tilted torso
- Excessive exercise
- Cystic fibrosis
- Bronchial asthma
- Recurrent bronchitis
- Taking sleeping pills and sedatives, anticholinergics
- Ingestion of nitrates
- Alcohol and smoking
- Herpes virus or cytomegalovirus infection
- Sliding hernia of the esophageal opening of the diaphragm
- Fungal lesions
Pathogenesis during Heartburn (GERD) in Children
Heartburn (GERD) is caused by gastroesophageal reflux. Acid reflux is considered a decrease in pH in the esophagus to 4.0 or less. It occurs when acidic gastric contents enter the cons. Alkaline reflux – an increase in pH in the esophagus to 7.5 or more when the duodenal contents, often bile and pancreatic juice, enter the organ cavity.
The following forms of reflux are described:
- Physiological gastroesophageal reflux that does not cause the development of reflux esophagitisThis complex diagnosis is given to people of any age, both for children and adults. It happens to those who are completely healthy. Symptoms appear after eating, the intensity is small, as is the duration.
- Pathological gastroesophageal refluxIt leads to damage to the mucous membrane of the esophagus. It can occur in the morning, day and night, regardless of the meal. The frequency is high – there can be more than 50 episodes per day. Extra-esophageal symptoms may also occur.
Gastroesophageal reflux can be the result of such reasons:
- The imbalance in the increase in body length and esophagus.
- Immaturity of the lower esophageal sphincter in children under 12-18 months.
- Absolute or relative failure of the cardia.
Symptoms of Heartburn (GERD) in Children
Symptoms of heartburn (GERD) in children are divided into two types: esophageal and extraesophageal.
Esophageal ones include regurgitation, heartburn, belching with bitter or sour air, a “wet spot” symptom, pain or discomfort during passage of food through the esophagus, periodic pain behind the sternum.
Extraesophageal symptoms:
- chronic pneumonia
- bronchial asthma
- bronchitis
- a feeling of “stuck” food or “lump” in the throat
- constant coughing
- pain in the ear
- erosion of tooth enamel and tooth decay
- arrhythmias due to the initiation of an esophagocardial reflex.
In infants and preschoolers, vomiting, mass deficiency may occur. Babies burp. Young children can also have anemia, respiratory disorders up to apnea and sudden death syndrome.
Diagnosis of Heartburn (GERD) in Children
X-ray diagnostics
Using X-ray images, the patency of the esophagus, the relief and diameter of the mucous membrane, the presence of ampoule-shaped extensions, and so on are evaluated.
Endoscopic examination
Shows morphological changes and motor disorders. Changes in the structure of tissues (morphological) can be I-IV degrees. The last, fourth, degree is characterized by an ulcer of the esophagus and stenosis.
Motor disturbances can be moderate, moderate and severe.
A histological examination is indicated for those patients who have a discrepancy between radiological and endoscopic data (in complex diagnostic cases), esophageal papillomatosis, suspected metaplastic process in the esophagus, suspected malignancy of the esophagus tumor, atypical course of erosive and ulcerative esophagitis.
Doctors can prescribe an intra-esophageal pH meter to determine pathological gastroesophageal reflux, an intra-esophageal impedance measurement, esophageal manometry (checking the function of the lower esophageal sphincter), ultrasound (reveals the diameter of the esophagus), radionuclide examination.
The diagnosis is formulated as follows: primary, complication, concomitant diagnosis.
Treatment of Heartburn (GERD) in Children
Non-drug treatment
Grudnichkov is treated with postural therapy – the child is fed, tilting it by 45-60 °. At night, they lift the end of the crib (where the baby’s head is) by 10-15 cm. For feeding, use condensed or coagulated mixtures that contain amylopectin, carob gluten and other thickeners.
Whether to use medicines to treat babies should be decided by the doctor in each specific case. There are no universal solutions.
Medication for heartburn (GERD) in older children:
Antacids, prokinetics, symptomatic agents, antisecretory drugs, reparants are used. Treatment is selected depending on the type of reflux, therefore self-medication is strictly prohibited! The choice of drugs should be made by the doctor, based on the results of the above diagnostic methods.
Surgery
Surgical methods of treatment are resorted to when the child has pronounced symptoms of GERD, which significantly affect the quality of life, and which do not disappear even when taking medications. Also, an indication for surgical correction of heartburn in children is a combination of GERD with a “true” hiatal hernia and complications of GERD.
Screening for heartburn (GERD) in children
The issue of clinical examination for this disease has not been fully resolved. It should be taken into account that GERD can be relapsed (in most cases), therefore it is necessary to monitor the child and implement preventive measures.
Heartburn in children is often combined with other organic diseases of the gastroduodenal zone.
Prevention of Heartburn (GERD) in Children
- The child must eat right.
- You should limit the intake of foods high in carbohydrates and those that increase acidity (this includes fast food, seasonings, citrus fruits).
- From the diet should be almost completely excluded products that contribute to the relaxation of the sphincter: sweets with menthol, peppermint, soda, chocolate, coffee.
- The last meal should be 2 hours before bedtime, no later than.
- During sleep, the head should be at a higher level than the legs. Sometimes the bed is angled.
- If necessary, take drugs that reduce the acidity of gastric juice.