Earliest sign of pathological gastroesophageal reflux in infants is?
A. Upper GI bleeding
B. Respiratory symptoms
C. Oesophageal stricture
D. Postprandial regurgitation
Correct answer : B. Respiratory symptoms
GASTROESOPHAGEAL REFLUX IN INFANTS
Gastroesophageal reflux in infants can be of 2 types – Physiological or Pathological.
Physiological reflux
The infant has regurgitation after feeding, but weight gain is normal.
There are no respiratory symptoms / features of oesophagitis.
Pathological reflux (gastroesophageal reflux disease)
Regurgitation is associated with refusal to eat, excessive vomiting, weight loss and failure to thrive.
The infant has recurrent respiratory features like like wheezing, stridor, chronic cough, aspiration, sore throat, hoarseness and recurrent pneumonitis.
Features of oesophagitis may be present – upper GI bleeding, anemia and Sandifer syndrome (torticollis and dystonia associated with GERD).
The most frequent complications are failure to thrive and recurrent respiratory symptoms.
Investigations
Upper GI imaging series
Upper GI endoscopy
Esophageal pH monitoring
Management
Conservative management
Small frequent feeds thickened with cereal.
Burping the infant.
Hold the infant in an upright position for 20-30 minutes after feeding.
Medical management
H2 blockers like ranitidine.
Proton pump inhibitors like omeprazole and pantoprazole.
Antacids like magnesium hydroxide.
Surgical management
Gastrostomy or fundoplication is done in a very small minority.