Esophagitis in infants symptoms. What causes gastroesophageal reflux in children and how is it treated? Gastroesophageal reflux in children - symptoms and treatment

Part 1
GERD in infants.

Gastroesophageal reflux disease in children of the first year of life. Information for patients.

(For GERD in children over the age of 1 year, read below, part 2)

Gastroesophageal reflux (GER) - This medical term denoting regurgitation (reverse reflux) of stomach contents into the esophagus and (sometimes) the mouth. Since certain acids are normally found in the lumen of the stomach, GER is sometimes (especially abroad) called acid reflux.

Reflux is a normal process and occurs in healthy babies, children and adults. Most babies have brief episodes during which they spit up milk or breastfeeding formula through their mouth and/or nose. Uncomplicated reflux usually does not bother the child, has a low risk of developing chronic complications and usually does not require treatment.

In contrast, children with gastroesophageal reflux disease (GERD) are whiny, gain weight more slowly, often have recurrent (repeated) pneumonia, or hemoptysis. Children with these symptoms usually require further evaluation and treatment. Although most children with gastroesophageal reflux disease (GERD) symptoms resolve on their own as they grow older, some children have these symptoms as they age.

WHAT IS GASTROESOPHAGEAL REFLUX DISEASE (GERD)?

When we eat, food passes into the esophagus and then into the stomach. The esophagus consists, among other things, of special muscle layers, which expand and contract to push food into the stomach with a series of undulating movements: this is called the peristaltic movement of the esophagus.

At the bottom of the esophagus, where it joins the stomach, there is a muscular ring called the lower esophageal sphincter (LES). When food reaches the LES, it relaxes to allow it to enter the stomach, and when food passes into the stomach, it closes to prevent food and stomach acid from refluxing back into the esophagus.

Sometimes this ring of muscle (LES) does not close completely, allowing fluid from the stomach to back up into the esophagus, this can happen in anyone but is most common in infants. Most of these episodes go unnoticed because reflux only affects lower part esophagus.

As the child grows, the angle between the stomach and esophagus increases, resulting in sharp decline reflux frequency. Spitting stops completely in more than half of children at 10 months of age, 80 percent of children at 18 months of age, and 98 percent of children at two years of age.

Uncomplicated gastroesophageal reflux Gastroesophageal reflux is very common in infants during the first months of life, approximately 50% of children aged 0-3 months have at least one regurgitation per day.

Babies who burp infrequently, eat enough food, have normal weight gain for their age, and don't have excessive tearfulness—have so-called "uncomplicated" reflux. Such regurgitation is a consequence of the anatomical features of a child of this age, since the short esophagus and the tiny volume of the stomach contribute to the reverse flow of fluid from it. Frequent release of air from the stomach and restriction physical activity after feeding may reduce the frequency and volume of regurgitation.

Children with uncomplicated reflux usually do not need additional diagnostics. If the symptoms increase, appear for the first time after six months of life, or do not decrease by the age of 18 to 24 months, the child should be shown to the pediatrician, and most likely will require a consultation with a gastroenterologist.

Gastroesophageal reflux disease (GERD). Simple reflux becomes gastroesophageal reflux disease when stomach acid begins to irritate or damage the esophagus. It occurs in a very small percentage of children who have frequent regurgitation. The onset of the disease is due to: high frequency reflux, large volume of reflux, or the inability of the esophagus to quickly neutralize the acid thrown into it. Treatment for gastroesophageal reflux disease (GERD) is directed at one or more of these factors.

Some of the signs or symptoms that may indicate GERD include: refusal to eat, frequent crying and arching of the neck and back (as if in pain), aspiration during spitting up, severe (fountain) vomiting, frequent coughing, or small weight gain . These symptoms are not normal and require further testing to confirm the diagnosis of GERD or identify another diagnosis.

It is often difficult to know if a baby is in pain. Usually a baby who cries from “banal” reasons can be consoled by distracting him, or by detecting and eliminating the factor that irritates him (wet diapers, hunger, desire to sleep, etc.).

Tearfulness and reflux. Many parents are concerned that reflux is the cause of their child's tearfulness or difficulty sleeping. However clinical researches showed that uncomplicated reflux usually does not cause pain, and reducing stomach acid does not reduce tearfulness.

Tearfulness and difficulty sleeping are not specific to GERD, and may be due to a variety of causes. Children who have frequent regurgitation and severe tearfulness should be examined by a doctor. If there are no other problems, a milk-exclusion diet and food thickeners may be recommended for such an infant. (See section " GERD treatment" below.)
DIAGNOSIS OF GERD

If a child is suspected of having gastroesophageal reflux disease, the first step in the evaluation should be a history and general examination. Whether further testing is needed depends on what the doctor determines, and may include the following:

Laboratory tests (blood and/or urine)
X-ray examination, in order to assess the swallowing function of the infant and the anatomy of his stomach
Endoscopy, to assess the condition of the esophagus
GERD TREATMENT

Babies with uncomplicated reflux do not require any treatment, but parents can be given some advice on how to make lifestyle changes for these babies. Such recommendations usually include: refusal to overeat (eat more often and in smaller volumes), avoiding any contact of the child with tobacco smoke, a diet with the exclusion of milk, and food thickeners. We will call these measures conservative(as opposed to medical and surgical measures).

Many children with reflux symptoms get relief from conservative measures. In one study, more than 80 percent of these children experienced complete or partial improvement in symptoms from conservative measures alone, such as food thickeners, avoidance of exposure to tobacco smoke, and reduced exposure to protein. cow's milk(mixtures based on partial protein hydrolysis, or the complete exclusion of milk from the mother's diet if the child is breastfed).

Diet with the exception of milk. Studies show that 15 to 40 percent of children with gastroesophageal reflux disease have cow's milk protein intolerance, or "dietary, protein-induced gastroenteropathy." Diagnosis of this condition in most children is based on their symptoms, and the degree of positive response to changes in diet; V laboratory research usually not necessary.

Most children with dietary protein-induced gastroenteropathy are intolerant of cow's milk protein alone, although some are also intolerant of soy proteins. To eliminate these proteins from the baby's diet, breastfeeding mothers should completely eliminate all dairy and soy products from your diet. IN rare cases it may be necessary to exclude other proteins from the mother's diet, but all this should happen only on the recommendation of the attending physician.

If a child's GERD symptoms improve after two to three weeks of the diet, it is advisable to continue the diet until the child is one year old. After this age, many children get rid of intolerance to milk proteins. If, after the diet is canceled, the symptoms return, the mother should return to the restrictions in her diet and the nutrition of the baby.

If the child is on artificial feeding, he may be offered a formula that does not contain milk and soy protein(hydrolysates). On this diet, the child is observed for 1-2 weeks to determine if the child's reflux symptoms are improving. If symptoms do not improve, the child may be advised to return to the original formula.

Almost all children with protein intolerance recover from it by the age of 1 year.

Food thickeners. Adapted formula with a thickener, or strained breast milk with the addition of a thickener, may help reduce the frequency of regurgitation and relieve symptoms in a child who is gaining well. In children under the age of three months, or children with allergies, thickeners can only be prescribed by a doctor. However, thickeners are not recommended as monotherapy (the only treatment) in infants whose esophagus is already damaged by acid reflux (i.e., children with esophagitis).

In the United States of America, substances derived from rice are commonly used as food thickeners, in other countries rice starch, corn and potato starch, carob flour, or carob bean gluten are often used. To thicken your baby's nutrition, one tablespoon of rice starch per 1 ounce (about 30 ml) of formula or expressed breast milk is usually used. The hole on the nipple of the bottle should be slightly larger than usual to allow the passage of thickened formula or breast milk. However, it should not be too large, so that the child does not choke if the mixture flows too quickly. If the doctor recommended feeding the child with thickeners, then the usual formula for the child, or expressed milk, is mixed immediately before feeding with a special baby thickener, which are sold in pharmacies. In addition, there are ready artificial mixtures containing thickeners in their composition.

Women who are breastfeeding are generally not advised to replace breast milk with formula, but only express and add a thickener. Breast milk itself has properties that help babies recover from GERD.

Body position. Babies may have fewer episodes of spitting up if they are in vertical position and in a state of physical and mental calm, within 20 to 30 minutes after feeding (i.e., the infant should be carried on the shoulder of an adult, and not put to bed after feeding). Parents should avoid large amounts of feeding, and should interrupt feeding as soon as the infant begins to lose interest in food and become distracted.

Drug therapy GERD. If the child's symptoms do not improve after conservative therapy described above, drugs that reduce the acidity of gastric contents may be recommended. Eat whole line drugs for the treatment of heartburn in adults. However, it should be remembered that the safety and efficacy of these drugs in children is completely different.

Children with uncomplicated gastroesophageal reflux (without esophagitis) should not be given drugs that reduce the acidity of gastric contents or the rate of gastric emptying.

Children with suspected GERD may have good dynamics symptoms when using short-term courses of drugs that block the production of acid in the stomach. Omeprazole and lansoprazole have been best studied in infants. If after the appointment of these drugs there is no noticeable decrease in manifestations of GERD, the course of treatment is most often interrupted.

Antacids (eg Maalox®) and others medicines acid-reducing drugs (eg, ranitidine, famotidine, etc.) are not as effective as omeprazole and lansoprazole in blocking stomach acid production, but may also help reduce symptoms.

All these medications, even considered harmless, antacids - can cause side effects and should never be used without prior consultation with a pediatrician.

When to ask for help:

Infants with a confirmed diagnosis of GERD should be seen by a doctor as soon as possible if they develop the following symptoms:

* Bloody stools, severe diarrhea, repeated vomiting, or vomiting blood
* Repeated pneumonia
* Delay weight gain
* Continuous baby crying for more than 2 hours
* Complete failure from food and water for a long period of time
* If the child is less than 3 months old, has profuse regurgitation after each feed and ends up being hungry
* If the child has significant behavioral changes, including excessive sleepiness or lethargy

The original article is here.

It is represented by the reverse reflux of the contents of the stomach into the esophagus, mouth. Since certain acids are present inside the lumen of the stomach, the disease is often called acid reflux. In this article, we will find out how reflux in children differs from reflux in adults.

Description of the disease

Reflux is considered normal process, which is present even in healthy infants and older children. Reflux in infants is noted in the form of brief episodes. They spit up milk, formula meant for breastfeeding. Regurgitation occurs through the mouth, nose. If the child's reflux is uncomplicated, no treatment is required.

Once inside the stomach, food passes through the esophagus. The esophagus is made up of several layers of muscle that have the ability to expand, contract, and push food into the stomach through a series of wave-like movements. After food enters the stomach, the esophageal sphincter closes. This prevents the return of food, stomach acid into the esophagus.

Reflux is noted when the muscle ring is not completely closed. Fluid from the stomach enters the esophagus. The frequency of reflux in babies decreases over time, this is facilitated by an increase in the angle between the stomach and esophagus. Fully reflux in newborns can be completely gone by 10 months (half of newborns), by 18 months (in 80%), by two years (98%).

In children, it can occur when the stomach is full of food. less commonly, this disease is the result of an allergy (food), narrowing esophageal opening. Also, this disease can occur if the newborn has congenital / acquired pathologies in the digestive system.

In the first months of life, gastroesophageal reflux (uncomplicated) is very common in infants. About one regurgitation per day occurs in 50% of children from 0 to 3 months.

Reflux nephropathy in children is represented by a disease from the group of nephritis. It is represented by tubulointerstitial nephritis, which usually occurs when the baby has persistent vesicoureteral reflux. With the development of this pathology within renal tissue rough scars appear.

This disease has symptoms similar to acute pyelonephritis. It is rather difficult to detect this pathology, it is necessary to use several types of diagnostics (ultrasound of the kidneys, biopsy, cystourethrogram, cystogram).

Symptoms

Click on the image to enlarge it

"Uncomplicated" reflux is characterized by the following features:

infrequent regurgitation;
eating enough food;
normal weight gain
lack of excessive tearfulness.

Regurgitation in infants is considered a consequence of anatomical features. Liquid flows out of the stomach due to the small volume of this organ, the short esophagus. The volume of regurgitation, the frequency is usually reduced due to the limitation of physical activity, the release of air from the stomach.

Additional diagnostics for uncomplicated reflux is not needed. With an increase in symptoms in the first 6 months of life, or they do not disappear by 18-24 months, a pediatrician is required. He may refer you to a gastroenterologist.

Simple reflux becomes a disease (GERD) when irritation occurs, damage to the esophagus by gastric acid. The onset of the disease is characterized by the appearance of frequent, voluminous refluxes. The esophagus is incapable of short time neutralize the acid that is thrown into it.

Among the most common symptoms of GERD we specify:

refusal to eat;
bad smell from mouth;
severe vomiting (like a fountain);
hiccups
arching of the back, neck;
frequent cough;
the timbre of the voice may change;
the presence of aspiration during regurgitation;
ear infection;
swallowing disorder;
little weight gain.

In the presence of such symptoms, an examination by a gastroenterologist and diagnostics are required.

Diagnostics

When GERD is observed in children under 2 years of age, they cry more often, slow weight gain is noted, in rare cases, hemoptysis, recurrent pneumonia may be present. In the presence of such signs, the child is prescribed further diagnostics, therapy.

If a specialist suspects gastroesophageal reflux disease, it will be necessary to take an anamnesis, conduct general inspection. For staging accurate diagnosis The specialist may prescribe the following types of examinations:

Endoscopy. It is necessary for the correct assessment of the condition of the esophagus.
X-ray examination. It is carried out to assess the child's swallowing function, to study the anatomy of a tiny stomach.
pH test. Carry out if necessary daily monitoring acidity. During this time, each episode of reflux, its duration, is noted. For this purpose, a probe equipped with a special sensor is inserted into the esophagus.
Laboratory tests (urinalysis, blood tests).
Sphincteromanometry. It is necessary to assess the tone of the lower esophageal sphincter.

Treatment

"Milikon";
"Gaviscon".

To neutralize, reduce the level of stomach acid, doctors usually prescribe the following drugs:

"Maalox", "Milanta" (antacids);
Aksid, Zantak, Pepsid, Tagamet (histamine-2 inhibitors);
"Protonix", "Nexium", "Eisifex", "Prilosek" (enzymes).

You may also need medicines that help improve bowel function:

"Propulsid";
"Erythromycin";
"Raglan".

In very rare cases it may be necessary surgical intervention. It consists in carrying out the Nissen operation, in which the upper part of the stomach is wrapped around the esophagus, thus creating a deflection that can shrink and close when the stomach is compressed. It is these actions that prevent reflux. This procedure considered absolutely effective, but at the expense of its safety it is better to consult a specialist.

Estimated price tags for treatment in the main centers

City	Name of medical institution	Name of the procedure	Price
St. Petersburg	"Profi Medica"	Examination by a pediatric gastroenterologist (initial appointment)	1200 rub.
MSC	Medswiss	Consultation pediatric gastroenterologist(up to 15, 30 km outside the Ring Road)	4 400 rub.
Volgograd	Dialine	Child gastroenterologist appointment (primary)	750 rub.
Ekaterinburg	European medical Center Children's polyclinic, (UMMC-Health)	Reception of a pediatric gastroenterologist (repeated)	1050 rub.
Nizhny Novgorod	Clinic Academy-VIP		1500 rub.
Novosibirsk	"Avicenna"	Reception (it includes examination, consultation) of a pediatric gastroenterologist	2 000 rub.
Samara	Clinics of Dr. Kravchenko	(Primary) appointment with a pediatric gastroenterologist	8 50 rub.
Permian	"Alfa Health Center"	Pediatric gastroenterologist appointment (primary)	RUB 1,167
Omsk	"Your Doctor"		800 rub.
Chelyabinsk	"Cardiocenter on Kashirinykh"	Gastroenterologist consultation	900 rub.
Minsk	Sante	Gastroenterologist consultation	31.77 rub.
Kyiv	"Harmony of health"	Primary consultation of a pediatric gastroenterologist	385 UAH
Odessa	Oxford Medical	Pediatric gastroenterologist	290 UAH
Kharkiv	"DocUa"	Gastroenterologist appointment	250 UAH
Dnepropetrovsk	"DocUa"	Pediatric gastroenterologist appointment	190 UAH
Almaty	"Dokok"	Pediatric gastroenterologist appointment	4 800 tenge

Prevention

To prevent this from occurring unpleasant state For children under 2 years of age, it is recommended:

slightly raise the baby's head in the crib;
keep the baby's head elevated for half an hour after eating;
give solid food (with the permission of the pediatrician);
Do not feed your baby too liquid food.

stay upright for more than 2 hours after eating;
feed the baby more often;
do not eat foods that can irritate the stomach;
play sports, be active (children);
if the baby has reflux, which is complicated by esophagitis, you should seek qualified help;
one should not be afraid of rare regurgitation in infancy;
try not to overfeed the baby so that there is no unwanted spitting up due to overeating.

If the baby has reflux, which is complicated by esophagitis, you should seek qualified help.
You should not be afraid of rare regurgitation in infancy.
Try not to overfeed your baby so that there is no unwanted spitting up due to overeating.

Up to 70% of children aged 3-7 months "return" the contents of the stomach more than once a day. The reason is that the milk reacts with stomach acid and is pushed out in the opposite direction, because the muscular valve is not yet sufficiently developed to contain burping.

Reflux is common in infants, especially in the first three months of life, but if the problem persists after this period or if you have any other cause for concern, see your doctor. This must be done in without fail when the following symptoms appear:

severe constipation;
bloody or completely black stools;
blue face, suffocation;
resumption of bouts of vomiting after reaching the age of six months;
bloating;
vomiting of bile;
vomiting "fountain".

Symptoms and signs of gastroesophageal reflux (GER) in newborns under one year old

lack of gain or weight loss;
crying caused by abdominal pain;
irritability during or after feeding;
fatigue;
belching;
prolonged anxiety;
cough;
arching the back when eating or refusing to feed.

Another variation of this problem is called silent reflux, or laryngeal reflux. It is more difficult to identify because it does not have unambiguous external manifestations. However, affected babies may show signs of discomfort, irritability, or even pain when lying down. In addition, because stomach acid irritates the upper respiratory tract, reflux disease is often accompanied by chronic cough, sore throat and hoarse crying.

Treatment of gastroesophageal reflux (GER) in newborns up to a year

Sometimes, to solve a problem, it is enough for a mother to adjust her own diet and the baby’s diet, but there are also additional tricks which, for example, helped my daughter a lot. I was glad that I managed to alleviate her condition without resorting to medical treatment.

If you are breastfeeding, then watch your diet. Some babies have unpleasant symptoms occur because the tiny digestive system cannot tolerate certain products. Avoid food that can irritate a child's stomach (these are dairy products, soy, eggs, peanuts, gluten, caffeine, spicy dishes), and try to determine if the child's well-being has changed. Eliminate several foods from the diet at once, and then return them one at a time, observing the reaction of the baby. Don't Eat Too Many Carbohydrates: A Low-Carb Diet Is Scientifically Proven effective way treatment of reflux disease, since the esophageal sphincter is controlled by insulin. Sugar is bad for a burping baby.
If the baby is breastfed, drink chamomile tea. The substances contained in chamomile, along with your milk, will go to the baby and relieve discomfort in his tummy.
Elevate the baby's head while feeding. Place a pillow under the back of his head so that the milk flows into the stomach and does not linger in the esophagus. Try to keep your baby upright after feedings and during activities such as changing a diaper or bathing.
Feed your baby little and often. Sometimes the symptoms are aggravated by the fact that the child takes too much food at once. In such cases, reducing the "portion" helps. If you are breastfeeding and milk is flowing strongly, choose a position in which the baby can receive exactly as much food as he needs. Don't forget to help your baby breathe out after each feed. In this case, it is desirable to keep the child upright.
Carry your baby on your back or on your stomach using a backpack that allows your baby to be upright and not put pressure on the stomach. This will reduce the frequency of spitting up.
Massage your baby. This activates the immature digestive system and help shape it. To relieve discomfort and achieve a soothing effect, you will need about 30 ml of organic massage oil for babies with the addition of a drop of lavender or chamomile oil.
Refer to homeopathy. A proven remedy for preventing reflux in infants is Natrium Phosphoricum at a 6x dilution (six times decimal dilution). Dissolve one tablet in milk and give to your child immediately after feeding. Or if you are breastfeeding, then take this medicine yourself 2 tablets after each meal: it will have a mild effect on the baby, naturally entering his body with your milk. Before using the drug, consult an experienced homeopath.

The children's type of illness is a problem that all parents have to face to one degree or another. How to get rid of reflux in a child, find out right now!

Symptoms of reflux in children

The symptoms of the disease are:

regurgitation - at infants;

child's anxiety (crying, moodiness);

growth retardation of the baby (with frequent and / or profuse regurgitation);

an older child may complain of a burning sensation in the chest, bitterness in the mouth.

Early symptoms diseases appear as aching pain upper abdomen, which are often worse after eating. There may also be seizures bronchial asthma. Reflux in infants is characterized by frequent regurgitation, frequent vomiting and poor weight gain.

Nonspecific signs of reflux in children

Nonspecific symptoms of the disease can be:

lack of appetite,

bad breath,

swallowing disorder,

frequent otitis.

Diagnosis of the disease in a child

The main diagnostic methods are esophagogastroduodenoscopy and radiopaque study gastrointestinal tract.

On initial stage reflux mark erosion distal esophagus,
in the middle stage, foci of inflammation coalesce into common area.
At the final stage, inflammation captures the entire area of the mucosa, and ulcers appear. At the fourth stage of reflux in a child, an esophageal ulcer, metaplasia of the esophageal mucosa (Barrett's esophagus), and stenosis are already clearly visible.

Features of the treatment of reflux in children

In infants, the disease usually resolves on its own by the age of one year against the background of the maturation of the gastrointestinal tract. If the attacks are frequent, plentiful, lead to a lag in physical development, then the pediatrician decides on drug therapy, appointment of a specialized anti-reflux mixture, additional examination.

How to get rid of reflux in a child - helpful tips

frequent small meals;

avoid reflux in children torso, lifting weights, jumping, especially after eating;

dinner no later than 3 hours before bedtime;

do not take a horizontal position immediately after eating;

do not wear tight belts;

limit the use of coffee, chocolate, fatty, spicy and fried food, dried fish and dried fruits, carbonated drinks, chewing gum;

avoid smoking (including passive),

To get rid of reflux, it is useful for a child to chew chewing gums- this increases the amount of saliva secreted, which is able to clear the esophagus from the resulting gastric juice.

Many children experience heartburn, which can last for 2-4 hours. Such patients are advised to raise the head of the bed so that the head and shoulders are higher than the abdomen and do not allow gastric juice to burp into the esophagus.

Appointment question drug treatment decided individually by the attending physician after receiving the results of the examination.

Medical treatment for reflux in children

In the treatment of acid reflux in children mild form drugs are prescribed that are dispensed without a doctor's prescription and contain antacids and histamine neutralizers, and you must also follow a diet.

Antacids are used for short-term and immediate elimination of the consequences of acid reflux. Gastric juice is neutralized after taking the drug for a short time and does not good effect. Antacids include tums maalokx, mulanta.

Histamine neutralizers reduce the percentage of juice produced in the stomach. They are not considered effective in neutralizing gastric juices, unlike proton pump inhibitors. TO histamine preparations for the treatment of reflux in a child, drugs such as Ranitidine, Cimetidine, Nizatidine, Famotidine are used. These medicines are taken by mouth one tablet twice a day and can be bought at any pharmacy without a doctor's prescription.

Causes and prevention of childhood reflux

Often referred to as gastroesophageal reflux disease, reflux is a disorder that is associated with the constant reflux of stomach contents into the esophagus and is accompanied by inflammation of the esophagus (esophagitis). The causes of the disease are most often anatomical disorders in the area of the transition of the stomach into the esophagus (this may be a hernia), a violation of the autonomic nervous regulation, inflammation of the stomach ( peptic ulcer, gastritis), a violation of the diet (systematic overeating), as well as taking certain medications.

Causes of Reflux in Babies

The causes of the disease can be:

immaturity digestive tract in infants;

improper feeding a child (in this case, aerophagia occurs - swallowing a large amount of air during feeding);

overfeeding (too much milk from the mother);

congenital and acquired pathology of the digestive system.

Causes of illness in older children

Reflux in older children occurs against the background of chronic gastroduodenal pathology, which can be congenital (cardiac sphincter insufficiency) or acquired (gastritis, peptic ulcer). In any case, it is necessary to contact a specialist for the purpose of examination and, if necessary, the appointment of treatment for reflux.

Frequent cases acid reflux in a child is food that relaxes the lower sphincter. A large number of in the child's menu of chocolate, caffeine, peppermint, enough fatty foods can trigger acid reflux in many people. .

Prevention of childhood reflux

In order to prevent regurgitation in an infant, it is recommended:

frequent feeding with reflux in children in small portions;

before feeding, the child is laid out on his stomach, which contributes to the release of gases;

food for reflux in children should be thick;

use an elevated position when feeding to prevent reflux;

do not put pressure on the baby's tummy during feeding, do not use tight swaddling;

after eating, hold the child in a “column” for 20-30 minutes so that the air swallowed during the meal comes out;

during sleep, lay the child on its side.

To prevent the disease in older children, you should try to avoid late snacks and overeating.

Esophagitis in children is a fairly common pathology among diseases of the esophagus. It is characterized by inflammation of the mucosa. With a severe degree of development, the deeper layers of the esophagus undergo changes. Esophagitis can develop as an independent disease, or occur against the background of other diseases. The cause of the manifestation of the disease is the release of stomach contents into the esophagus (reflux). If the condition recurs, the occurrence is likely serious consequences: the formation of ulcers, scarring of the esophagus, its narrowing or shortening. Over time, the disease can lead to oncological pathologies.

Reflux observed in infants, in most cases, is not considered a pathology, since it is caused by a weak muscular system esophagus and sphincter, sphericity and small size of the stomach, its rapid filling and slow emptying. Therefore, for the first 3 months of life in infants, regurgitation after eating, hiccups are considered common. The condition does not require treatment, you need to feed the baby at an angle of 60 degrees, after feeding it is necessary to keep him in an upright position so that the air that has entered the stomach is released. You need to put the baby on the barrel so that when regurgitation, the food mass does not enter the respiratory tract. With a tendency to frequent reflux, the child should be put to bed so that top part the body was slightly higher. You can put it on your pillow.

Preventive measures can prevent the development of esophagitis.

Diagnosis of reflux esophagitis in childhood quite difficult, because the child cannot explain what is causing him anxiety. Treatment of esophagitis in children is also difficult because many medications are not allowed to be used in childhood.

Esophagitis is inflammatory process caused by the ejection of stomach contents into the esophagus. At normal condition the contents of the stomach cannot enter the esophagus because the muscular sphincter at the bottom of this organ is closed and prevents it. It opens in time to enter food into the stomach and closes in time. When the function of the sphincter is impaired and the muscle ring does not close completely, then gastric juices and acids enter the esophagus along with digested food. Contact of the contents of the stomach with the mucous membrane causes the development of reflux esophagitis.

Reflux esophagitis is also seen in healthy children, while the condition is short-term, so the child does not feel changes and discomfort.

When the state repeats in a periodic manner, causing bad feeling child, you need to seek medical attention.

What it looks like, photo

As a result of the development of reflux esophagitis, you can see changes in the contours of the esophagus, ulceration, swelling of the walls and accumulation of mucus.

At normal functioning the muscular ring opens the lumen for the passage of food into the stomach through the esophagus and closes it tightly in a timely manner, since the peristalsis of the sphincter is not disturbed.

When the muscle ring is weakened and its functionality is impaired, pathological condition. Stomach acid returns to the esophagus with food. Gastric juice in the composition of the mass coming back causes irritation and inflammation of the mucous membrane of the esophagus. As a result of an anatomical anomaly, the stomach protrudes through a weakened diaphragm.

Symptoms

Toddlers infancy the cause of reflux may be an overflow of the stomach with food, rarely - food allergy, narrowing of the esophageal opening. Children may have congenital or acquired pathologies of the digestive system.

In older children, reflux develops as a result of gastroduodenal diseases, mainly with insufficiency of the cardiac sphincter, with acute or chronic gastritis, with a stomach ulcer and 12 - intestinal rings. In children school age reflux can develop as a result of irregular eating and overuse sweets, fatty foods, sweets.

Parents should be attentive to the child's complaints when they notice anxiety, refusal to eat for a long time. Symptoms of the disease may be non-specific, it can be confused with other diseases. The child may experience:

Reflux is almost always found in newborns. It's normal to spit up when they wear rare character And while the baby does not lose weight. At healthy child reflux rarely appears after the 4th month, and completely disappears by the 10th month. During this period, the condition does not require treatment. If after that the child has reflux recurs, you need to see a doctor. In infants, the disease occurs:

colic;
The formation of gases in the intestines and the difficulties of their discharge;
Repeated swallowing of food.

In some cases, reflux can be dangerous to health. Urgently consult a doctor if you observe the ineffectiveness of conventional medicines against reflux and if the baby is losing weight rapidly. anxiety symptoms are:

Difficulty in swallowing food;
Black color of vomit or traces of blood in them;
Sudden fever;
Hiccups that do not go away for a long time;
Chair in black.

signs

Signs of gastroesophageal reflux in children under 5 years of age can manifest themselves in different ways. The baby may complain of an unpleasant bitter - sour taste in the mouth, may refuse to eat, because after each meal there are pains. The child's breathing becomes difficult, especially when little patient suffers from asthma, begins to lose weight, vomiting appears.

In older children and adolescents, it is easier to determine the disease, as they can characterize pain, discomfort. Specific features are:

Taste of acid in the mouth or in the esophagus;
Nausea;
Heartburn, burning and pain in chest(in the middle of the chest);
Pain during meals;
Feeling of poor passage of food through the food pipe.

The pain may worsen during sleep.

Signs of the disease in one-year-old children are arching of the back or neck from a feeling of pain, gushing vomiting, refusal to feed, crying before and after feeding.

Classification and degrees

Pathological reflux occurs in acute and chronic forms.

The acute form of the disease develops against the background of existing diseases of the gastrointestinal tract. The main symptoms of this form are disruption of the gastrointestinal tract, the presence of a focus of infection in the body, vitamin deficiency. The baby looks unhealthy, there are difficulties in swallowing, pain in the chest.

The chronic course of the disease manifests itself as a complication of another disease of the digestive system. Infrequently, esophagitis occurs primarily, due to the specifics of nutrition. leaking chronic form reflux with severe symptoms.

Depending on the nature of the disease in a child, the following types of reflux are classified:

There are four degrees of development of the disease. Symptoms and treatment regimen depend on the degree.

In the first degree of pathological reflux, irritation of the esophagus by the contents of the stomach is observed. Under the influence of an aggressive substance contained in the mass, the mucous membrane of the esophagus swells, becomes red, single erosive lesions are recorded. Symptoms at this stage are absent or mild.
In the second degree, esophagitis occurs with certain symptoms, which is associated with an erosive lesion of the esophageal mucosa. On the mucosa there are spots 3-6 mm in size, which sometimes merge, gradually capturing the entire surface of the esophagus.
The third degree of pathology in a baby is characterized by severe symptoms. Difficulty in the process of swallowing is fixed, severe pain, the formation of defects on mucosa of the esophagus, a feeling of discomfort in the stomach area. With this degree, the lesion of the esophagus occupies more than 70%. Ulcerative lesions coalesce. The child complains of a burning sensation and heaviness in the chest, especially after eating.
The fourth degree is expressed by scale ulcerative lesion esophagus (more than 75%). Symptoms are more pronounced, constantly disturbing the child. The patient complains of pain in the stomach area, bad taste in the mouth, swallowing becomes impossible against the background severe discomfort and burning. This stage is the most dangerous and difficult for the baby, since this is a trait after which there is a risk of developing oncological diseases GIT.

Pathological reflux is detected in most cases from the second degree, when the symptoms become pronounced. In the third and fourth degree, surgical intervention is often resorted to.

Extraesophageal manifestations include:

bronchopulmonary;
Otolaryngologically;
Cardiology;
Dental.

ICD code 10

According to the ICD - 10 ( international classification diseases), esophagitis refers to diseases of the esophagus, stomach and 12 - rings of the intestine. Reflux - esophagitis according to ICD - 10 has a classification of K 21.0 - reflux with esophagitis, K 21.9 - without esophagitis.

The Savary Miller classification is also applied:

Grade A. The affected area of the esophagus reaches up to 4 mm, ulcers are observed that do not merge with each other;
Grade B. The affected area is enlarged to 5 mm. Erosive areas can merge in places;
Grade C. The area affected by ulcers reaches up to the 5th part of the esophagus;
Degree D. The esophagus is affected by 75%.

Clinical recommendations of pediatricians are based on the study of anamnesis, clinical and laboratory data and results instrumental research. With the help of anamnesis, the pediatrician is able to establish the presence of dysphagia, a wet spot symptom, and other typical manifestations. In the KLA, a decrease in the level of erythrocytes and hemoglobin can be detected (with posthemorrhagic anemia) or neutrophilic leukocytosis and a shift of the leukocyte formula to the left (with bronchial asthma).

The doctor prescribes endoscopic diagnostics- fibrogastroduodenoscopy, which allows to detect pathology on the mucosa, take biomaterial for research, see anatomical anomalies of the esophagus, assess the condition of the stomach.

Pressure is also measured inside the gastrointestinal tract, ultrasound, contrast x-ray examination, which reveals hernias, narrowing, evacuation dysfunction upper divisions GIT. An important indicator is a procedure for daily measurement of ph inside the esophagus.

Treatment regimen

If gastroesophageal reflux disease is not complicated (first or second degree), infants are treated simple change power mode:

Reduce portions of food, overeating should not be allowed;
Exclude contact of the baby with tobacco smoke;
Whole milk is removed from the diet.

If a child has abundant and frequent spitting up, this can lead to dehydration and a violation of water - electrolyte balance. In such cases, the treatment of the baby is organized in stationary conditions using infusion solutions.

For non-infant children, treatment is chosen by narrow specialists based on research, taking into account the individual specifics of the child's body.

use following groups medicines:

PPI - inhibitors proton pump. Block the formation of hydrochloric acid. Apply Omeprazole, Pantaprazol. Omeprazole is recommended for the treatment of children from 2 years of age.
H2 blockers - histamine receptors. Reduce the acidity of gastric juice. These include Ranitidine, Famotidine. It is not allowed to use for the treatment of children under 1 year.
Antacids. Neutralize hydrochloric acid, restore damaged areas of the mucosa. Phosphalugel, Maalox, Gaviscon are prescribed.
Prokinetics. They activate the contraction of the muscles of the stomach, increase the tone of the esophageal sphincter, normalize the process of gastric emptying, reduce reflux.
Enzyme medicines that help digest food.
Medications to combat flatulence. The use of Melikon is recommended.

The above drugs are used in symptomatic therapy but do not eliminate the cause of the disease.

In most cases, the third and fourth stages of reflux esophagitis require surgical intervention.

The indications for surgery are:

Ineffectiveness of long-term drug treatment;
Strong pain syndrome(pain does not subside after taking painkillers);
Deep damage to the mucosa, when multiple erosions and ulcers are fixed, occupying a large extent of the organ;
aspiration syndrome;
severe obstruction respiratory tract(complication of esophagitis).

The operation is performed by laparoscopic fundoplication, during which the sphincter muscle in the lower part of the esophagus is strengthened.

Folk remedies

For the treatment of esophagitis in children, herbal teas and decoctions from medicinal herbs. Before using prescriptions traditional medicine be sure to check the reaction of the baby's body to the compositions used and consult a doctor.

Collection of thyme and marshmallow

In equal quantities, thyme and marshmallow rhizomes are taken. 40 g of the collection is poured into 250 ml of boiling water and infused for 2 hours.

Tincture of mint, valerian and celandine

Cooking herbal collection mint, valerian, celandine (2:2:1). 20 g of the collection is poured into 250 ml of boiling water and heated in a water bath for 20 minutes.

dill tincture

2 h. L. ground seeds dill pour 200 ml of boiling water, insist 3 hours. The infusion is consumed after straining, 3 times a day, 1 tbsp. l. before eating.

Useful sweet water or water on flower honey(1 tbsp. Product for 1/3 warm water), which is prepared at night and given to the child in the morning.

Prevention

To prevent the development of esophagitis in children, you need to monitor their lifestyle and regimen. You can’t smoke with a child, teenagers need to explain the harm of smoking and alcoholic beverages to the body. The diet of the baby should include only healthy foods, need more fresh vegetables, fruits.

It is necessary to feed the child after checking the temperature of porridge, drinks. Do not consume very hot or cold food. To avoid chemical burns household chemicals must be kept out of the reach of children. During the treatment period, a sparing diet is recommended. Regular examinations by narrow specialists are advised, which will give the opportunity to detect and treat the pathology in a timely manner, preventing possible complications.

All parents should remember that self-medication is dangerous for the health of the child.

Diet

For infants the best option is breast-feeding. Food thickeners (corn, potato, rice starch) are added to the menu. This will help prevent food from leaking from the stomach into the esophagus. According to the version of American scientists, in the food of a child from 0 to 3 months, you can add a maximum of 1 tablespoon of a thickener per 30 ml of liquid.

For children preschool age and adolescents use a sparing diet. The diet is made taking into account that food intake is regular and crushed. You need to eat 6 times a day, in small portions at exactly the right time.

The child should eat only freshly prepared meals from foods that are easy to digest. It is necessary to exclude legumes, fibrous products, fruits with skin.

All drinks and dishes should be used in a warm (non-hot) form, since the inflamed mucosa is sensitive to the temperature of the food used.

It is advised to include soups from cereals, vegetable broths, boiled and chopped meat and fish, pureed cereals, kissels in the diet. Should not be given to a child rich soups, spicy, spicy, sour dishes. It is forbidden to use sweets with dyes, chocolate, fast food, sausages, fresh bread, sweets, carbonated drinks. Water should be given little by little, but regularly.

Treatment of esophagitis in children is complicated by the fact that small patients find it difficult to explain what worries them. Parents should be attentive to the behavior of the child, at the first sign of digestive problems, contact a specialist. Timely treatment child prevents the transition of the disease to a more complex degree of development, gives the opportunity to quickly and effectively cure the child using medicines.