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Pedıatrıc Gastroesophageal Reflux Dısease: Clınıc, Dıagnosıs And Treatment

Yıl 2018, Cilt: 10 Sayı: 1, 30 - 38, 21.01.2018

Öz

Abstract

Gastroesophageal reflux (GER) is defined as the involuntary retrograde passageof gastric contents into the esophagus with or without regurgitation or vomiting. GERis a normal physiologic process occurring several times per day in healthy infants.Gastroesophageal reflux disease (GERD) occurs when reflux of the gastric contentscauses symptoms that affect the quality of life or pathologic complications, such asfailure to thrive, feeding or sleeping problems, chronic respiratory disorders, esophagitis, hematemesis, apnea and apparent life-threatening events. A reflux symptomin children, unlike adults, varies according to age group. History and physical examination is the gold standard for the diagnosis of GERD. It is important to definewhich children have GERD to offer optimal treatment and to avoid costly and potentially invasive diagnostic testing. The recommendation on management ofGERD in children has always been a step-up approach, starting with parental reassurance, positional treatment, dietary recommendations, medical or surgical therapy.  Atypical presentations, complicated GER or failure to response to empiric management are indications for further diagnostic evaluations.

Kaynakça

  • Kaynaklar 1.Vandenplas Y, Hassall E. Mechanisms of gastroesophagealreflux and gastroesophageal reflux disease. J Pediatr Gastro-enterol Nutr 2002; 35 (2): 119-36. 2.Vandenplas Y, Rudolph CD, Di Lorenzo C, et al, North Ame-rican Society for Pediatric Gastroenterology Hepatology andNutrition, European Society for Pediatric GastroenterologyHepatology and Nutrition. Pediatric gastroesophageal refluxclinical practice guidelines: joint recommendations of the NorthAmerican Society for Pediatric Gastroenterology, Hepatology,and Nutrition (NASPGHAN) and the European Society for Pe-diatric Gastroenterology, Hepatology, and Nutrition (ESPG-HAN). J Pediatr Gastroenterol Nutr 2009; 49 (4): 498-547. 3.Hegar B, Vandenplas Y. Gastroesophageal reflux: natural evo-lution, diagnostic approach and treatment. Turk J Pediatr 2013;55 (1): 1-7. 4.Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalen-ce of symptoms of gastroesophageal reflux during infancy: apediatric practice-based survey: Pediatric Practice ResearchGroup. Arch Pediatr Adolesc Med 1997; 151: 569-72. 5.Carroll MW, Jacobson K. Gastroesophageal reflux disease inchildren and adolescents: when and how to treat. PaediatrDrugs 2012; 14 (2): 79-89. 6.Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosisand management of gastroesophageal reflux disease. Am J Gas-troenterol 2013; 108 (3): 308-28. 7.Rubenstein JH, Chen JW. Epidemiology of gastroesophageal ref-lux disease. Gastroenterol Clin North Am 2014; 43 (1): 1-14. 8.Arad-Cohen N, Cohen A, Tirosh E. The relationship betwe-en gastroesophageal reflux and apnea in infants. J Pediatr2000; 137 (3): 321-26. 9.Orlanco RC. Pathophysiology of gastroesophageal reflux di-sease. In: Castell DO, Richter JE, eds. The Esophagus, 3rd ed.Philadelphia: Lippincott, Williams & Wilkins 1999: 409–19. 10.Hassall E. Decisions in diagnosing and managing chronic gas-troesophageal reflux disease in children. J Pediatr 2005; 146(3): 3-12. 11.Lightdale JR, Gremse DA. Gastroesophageal reflux: mana-gement guidance for the pediatrician. Pediatrics 2013; 131(5): e1684-95. 12.Nielsen RG, Kruse-Andersen S, Husby S. Low reproducibilityof 2 x 24- hour continuous esophageal pH monitoring in in-fants and children: a limiting factor for interventional studi-es. Dig Dis Sci 2003; 48: 1495-502. 13.Craig WR, Hanlon-Dearman A, Sinclair C, Taback S, Mof-fatt M. Metoclopramide, thickened feedings, and positioningfor gastrooesophageal reflux in children under two years. Coch-rane Database Syst Rev 2004: CD003502. 14.Corvaglia L, Rotatori R, Ferlini M, Aceti A, Ancora G, Fal-della G. The effect of body positioning on gastroesophagealreflux in premature infants: evaluation by combined impedan-ce and pH monitoring. J Pediatr 2007; 151 (6): 591-96. 15.Bhat RY, Rafferty GF, Hannam S, Greenough A. Acid gastroesop-hageal reflux in convalescent preterm infants: effect of posture andrelationship to apnea. Pediatr Res 2007; 62 (5): 620-23. 16.Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA,Castell DO. Influence of spontaneous sleep positions on night-time recumbent reflux in patients with gastroesophageal ref-lux disease. Am J Gastroenterol 1999; 94 (8): 2069-73. 17.Omari TI, Rommel N, Staunton E, et al. Paradoxical impact ofbody positioning on gastroesophageal reflux and gastric empt-ying in the premature neonate. J Pediatr 2004; 145 (2): 194-200. 18.Chiba N, De Gara CJ, Wilkinson JM, Hunt RH. Speed of healingand symptom relief in grade II to IV gastroesophageal reflux disea-se: a meta-analysis. Gastroenterology 1997; 112 (6): 1798-810. 19.McCarty-Dawson D, Sue SO, Morrill B, Murdock RH Jr. Ra-nitidine versus cimetidine in the healing of erosive esophagi-tis. Clin Ther 1996; 18 (6): 1150-60. 20.Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA,Castell DO. Influence of spontaneous sleep positions on night-time recumbent reflux in patients with gastroesophageal ref-lux disease. Am J Gastroenterol 1999; 94 (8): 2069-73. 21.Canani RB, Cirillo P, Roggero P, et al; Working Group onIntestinal Infections of the Italian Society of Pediatric Gas-troenterology, Hepatology and Nutrition (SIGENP). Therapywith gastric acidity inhibitors increases the risk of acute gas-troenteritis and community-acquired pneumonia in children.Pediatrics 2006; 117 (5): 817-20. 22.Guillet R, Stoll BJ, Cotten CM, et al; National Institute of ChildHealth and Human Development Neonatal Research Network.Association of H2-blocker therapy and higher incidence of nec-rotizing enterocolitis in very low birth weight infants. Pedi-atrics 2006; 117 (2): 137-42. 23.Brewster UC, Perazella MA. Proton pump inhibitors and thekidney: critical review. Clin Nephrol 2007; 68 (2): 65-72. 24.Pritchard DS, Baber N, Stephenson T. Should domperidonebe used for the treatment of gastro-oesophageal reflux in child-ren? Systematic review of randomized controlled trials in child-ren aged 1 month to 11 years old. Br J Clin Pharmacol 2005;59 (6): 725-29. 25.Machida HM, Forbes DA, Gall DG, Scott RB. Metoclopra-mide in gastroesophageal reflux of infancy. J Pediatr 1988;112 (3): 483-87. 26.Putnam PE, Orenstein SR, Wessel HB, Stowe RM. Tardivedyskinesia associated with use of metoclopramide in a child.J Pediatr 1992; 121 (6): 983-85. 27.Del Buono R, Wenzl TG, Ball G, Keady S, Thomson M. Effectof Gaviscon infant on gastro-oesophageal reflux in infants as-sessed by combined intraluminal impedance/pH. Arch Dis Child2005; 90 (5): 460-63. 28.Goldin AB, Sawin R, Seidel KD, Flum DR. Do antireflux ope-rations decrease the rate of reflux-related hospitalizations inchildren? Pediatrics 2006; 118 (6): 2326-33.

Pediatrik Gastroösofageal Reflü Hastalığı: Klinik, Tanı ve Tedavi

Yıl 2018, Cilt: 10 Sayı: 1, 30 - 38, 21.01.2018

Öz

Öz

Gastroösofageal reflü (GÖR); sağlıklı bireylerde mide içeriğinin regürjitasyon yada kusma olmaksızın istemsiz olarak ösofagusa geçişi olarak tanımlanır. GÖR, sağ-lıklı infantlarda günde birkaç kez olabilen fizyolojik bir durumdur. Gastroösofageal reflü hastalığı (GÖRH) ise; hayat kalitesini etkileyen ya da büyüme-gelişme geriliği, beslenme/uyku problemleri, kronik solunum yolu hastalıkları, ösofajit, hematemez, apne ve akut hayat tehdit edici olay (ALTE) gibi komplikasyonlara neden olabilen patolojik bir tablodur. Erişkinlerden farklı olarak çocuklarda reflü semptomları yaş gruplarına göre değişiklik gösterir. Detaylı öykü ve dikkatli fizik muayenetanıda ve GÖRH'na bağlı olası komplikasyonları değerlendirmede en önemli basamaklardır. GÖR ya da GÖRH tanısında gereksiz incelemelerden ve tedavilerden kaçınmaya dikkat edilirken, sekonder reflü nedenleri ve olası komplikasyonlar göz ardıedilmeden hasta değerlendirilmelidir. GÖRH yönetiminde aile eğitimi, pozisyoneltedavi, diyetin düzenlenmesi, medikal ya da cerrahi tedavi yaklaşımları şeklinde tedavi basamakları uygulanır. Atipik klinik tablo, komplike olmuş GÖRH varlığındaya da ampirik tedaviye yeterli cevap alınamazsa ileri inceleme yapılması gereklidir.

Kaynakça

  • Kaynaklar 1.Vandenplas Y, Hassall E. Mechanisms of gastroesophagealreflux and gastroesophageal reflux disease. J Pediatr Gastro-enterol Nutr 2002; 35 (2): 119-36. 2.Vandenplas Y, Rudolph CD, Di Lorenzo C, et al, North Ame-rican Society for Pediatric Gastroenterology Hepatology andNutrition, European Society for Pediatric GastroenterologyHepatology and Nutrition. Pediatric gastroesophageal refluxclinical practice guidelines: joint recommendations of the NorthAmerican Society for Pediatric Gastroenterology, Hepatology,and Nutrition (NASPGHAN) and the European Society for Pe-diatric Gastroenterology, Hepatology, and Nutrition (ESPG-HAN). J Pediatr Gastroenterol Nutr 2009; 49 (4): 498-547. 3.Hegar B, Vandenplas Y. Gastroesophageal reflux: natural evo-lution, diagnostic approach and treatment. Turk J Pediatr 2013;55 (1): 1-7. 4.Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalen-ce of symptoms of gastroesophageal reflux during infancy: apediatric practice-based survey: Pediatric Practice ResearchGroup. Arch Pediatr Adolesc Med 1997; 151: 569-72. 5.Carroll MW, Jacobson K. Gastroesophageal reflux disease inchildren and adolescents: when and how to treat. PaediatrDrugs 2012; 14 (2): 79-89. 6.Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosisand management of gastroesophageal reflux disease. Am J Gas-troenterol 2013; 108 (3): 308-28. 7.Rubenstein JH, Chen JW. Epidemiology of gastroesophageal ref-lux disease. Gastroenterol Clin North Am 2014; 43 (1): 1-14. 8.Arad-Cohen N, Cohen A, Tirosh E. The relationship betwe-en gastroesophageal reflux and apnea in infants. J Pediatr2000; 137 (3): 321-26. 9.Orlanco RC. Pathophysiology of gastroesophageal reflux di-sease. In: Castell DO, Richter JE, eds. The Esophagus, 3rd ed.Philadelphia: Lippincott, Williams & Wilkins 1999: 409–19. 10.Hassall E. Decisions in diagnosing and managing chronic gas-troesophageal reflux disease in children. J Pediatr 2005; 146(3): 3-12. 11.Lightdale JR, Gremse DA. Gastroesophageal reflux: mana-gement guidance for the pediatrician. Pediatrics 2013; 131(5): e1684-95. 12.Nielsen RG, Kruse-Andersen S, Husby S. Low reproducibilityof 2 x 24- hour continuous esophageal pH monitoring in in-fants and children: a limiting factor for interventional studi-es. Dig Dis Sci 2003; 48: 1495-502. 13.Craig WR, Hanlon-Dearman A, Sinclair C, Taback S, Mof-fatt M. Metoclopramide, thickened feedings, and positioningfor gastrooesophageal reflux in children under two years. Coch-rane Database Syst Rev 2004: CD003502. 14.Corvaglia L, Rotatori R, Ferlini M, Aceti A, Ancora G, Fal-della G. The effect of body positioning on gastroesophagealreflux in premature infants: evaluation by combined impedan-ce and pH monitoring. J Pediatr 2007; 151 (6): 591-96. 15.Bhat RY, Rafferty GF, Hannam S, Greenough A. Acid gastroesop-hageal reflux in convalescent preterm infants: effect of posture andrelationship to apnea. Pediatr Res 2007; 62 (5): 620-23. 16.Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA,Castell DO. Influence of spontaneous sleep positions on night-time recumbent reflux in patients with gastroesophageal ref-lux disease. Am J Gastroenterol 1999; 94 (8): 2069-73. 17.Omari TI, Rommel N, Staunton E, et al. Paradoxical impact ofbody positioning on gastroesophageal reflux and gastric empt-ying in the premature neonate. J Pediatr 2004; 145 (2): 194-200. 18.Chiba N, De Gara CJ, Wilkinson JM, Hunt RH. Speed of healingand symptom relief in grade II to IV gastroesophageal reflux disea-se: a meta-analysis. Gastroenterology 1997; 112 (6): 1798-810. 19.McCarty-Dawson D, Sue SO, Morrill B, Murdock RH Jr. Ra-nitidine versus cimetidine in the healing of erosive esophagi-tis. Clin Ther 1996; 18 (6): 1150-60. 20.Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA,Castell DO. Influence of spontaneous sleep positions on night-time recumbent reflux in patients with gastroesophageal ref-lux disease. Am J Gastroenterol 1999; 94 (8): 2069-73. 21.Canani RB, Cirillo P, Roggero P, et al; Working Group onIntestinal Infections of the Italian Society of Pediatric Gas-troenterology, Hepatology and Nutrition (SIGENP). Therapywith gastric acidity inhibitors increases the risk of acute gas-troenteritis and community-acquired pneumonia in children.Pediatrics 2006; 117 (5): 817-20. 22.Guillet R, Stoll BJ, Cotten CM, et al; National Institute of ChildHealth and Human Development Neonatal Research Network.Association of H2-blocker therapy and higher incidence of nec-rotizing enterocolitis in very low birth weight infants. Pedi-atrics 2006; 117 (2): 137-42. 23.Brewster UC, Perazella MA. Proton pump inhibitors and thekidney: critical review. Clin Nephrol 2007; 68 (2): 65-72. 24.Pritchard DS, Baber N, Stephenson T. Should domperidonebe used for the treatment of gastro-oesophageal reflux in child-ren? Systematic review of randomized controlled trials in child-ren aged 1 month to 11 years old. Br J Clin Pharmacol 2005;59 (6): 725-29. 25.Machida HM, Forbes DA, Gall DG, Scott RB. Metoclopra-mide in gastroesophageal reflux of infancy. J Pediatr 1988;112 (3): 483-87. 26.Putnam PE, Orenstein SR, Wessel HB, Stowe RM. Tardivedyskinesia associated with use of metoclopramide in a child.J Pediatr 1992; 121 (6): 983-85. 27.Del Buono R, Wenzl TG, Ball G, Keady S, Thomson M. Effectof Gaviscon infant on gastro-oesophageal reflux in infants as-sessed by combined intraluminal impedance/pH. Arch Dis Child2005; 90 (5): 460-63. 28.Goldin AB, Sawin R, Seidel KD, Flum DR. Do antireflux ope-rations decrease the rate of reflux-related hospitalizations inchildren? Pediatrics 2006; 118 (6): 2326-33.
Toplam 1 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm makale
Yazarlar

Prof. Dr. Deniz Ertem

Yayımlanma Tarihi 21 Ocak 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 10 Sayı: 1

Kaynak Göster

APA Ertem, P. D. D. (2018). Pediatrik Gastroösofageal Reflü Hastalığı: Klinik, Tanı ve Tedavi. Klinik Tıp Pediatri Dergisi, 10(1), 30-38.
AMA Ertem PDD. Pediatrik Gastroösofageal Reflü Hastalığı: Klinik, Tanı ve Tedavi. Pediatri. Ocak 2018;10(1):30-38.
Chicago Ertem, Prof. Dr. Deniz. “Pediatrik Gastroösofageal Reflü Hastalığı: Klinik, Tanı Ve Tedavi”. Klinik Tıp Pediatri Dergisi 10, sy. 1 (Ocak 2018): 30-38.
EndNote Ertem PDD (01 Ocak 2018) Pediatrik Gastroösofageal Reflü Hastalığı: Klinik, Tanı ve Tedavi. Klinik Tıp Pediatri Dergisi 10 1 30–38.
IEEE P. D. D. Ertem, “Pediatrik Gastroösofageal Reflü Hastalığı: Klinik, Tanı ve Tedavi”, Pediatri, c. 10, sy. 1, ss. 30–38, 2018.
ISNAD Ertem, Prof. Dr. Deniz. “Pediatrik Gastroösofageal Reflü Hastalığı: Klinik, Tanı Ve Tedavi”. Klinik Tıp Pediatri Dergisi 10/1 (Ocak 2018), 30-38.
JAMA Ertem PDD. Pediatrik Gastroösofageal Reflü Hastalığı: Klinik, Tanı ve Tedavi. Pediatri. 2018;10:30–38.
MLA Ertem, Prof. Dr. Deniz. “Pediatrik Gastroösofageal Reflü Hastalığı: Klinik, Tanı Ve Tedavi”. Klinik Tıp Pediatri Dergisi, c. 10, sy. 1, 2018, ss. 30-38.
Vancouver Ertem PDD. Pediatrik Gastroösofageal Reflü Hastalığı: Klinik, Tanı ve Tedavi. Pediatri. 2018;10(1):30-8.