Gastroesophageal refers to the stomach and esophagus. Reflux means flow back or return. Gastroesophageal reflux is the return of the stomach's contents back up into the esophagus. In children, this reflux may be aspirated (sucked into the lungs) causing repeated bouts of pneumonia or asthma. In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the lower esophageal sphincter is weak or relaxes allowing the stomach contents to flow up into the esophagus. The degree of the reflux depends on the LES as well as the type and amount of fluid brought up from the stomach.
An upper GI series may be performed. This is a special x-ray that shows the esophagus, stomach and duodenum (the upper part of the small intestine). Your child will be asked to drink some barium or barium may be put into the stomach through the child's feeding tube. The radiologist will take pictures to track the barium as it leaves the stomach or refluxes back up the esophagus. You will be allowed to stay with your child during testing.
For children in whom diagnosis is difficult, a pH probe study may be done to measure the acid levels inside the esophagus. Testing pH monitors the acid level of the esophagus and symptoms during meals, activity and sleep. In this study, a small probe is placed into the child's esophagus and the acidity of the fluids within the esophagus is recorded for several hours. Sometimes other x-ray studies are needed.
Depending on the severity of the GER, medications may be tried. To reduce acid in the stomach, a medicine such as Zantac (ranitidine) may be used. To increase the strength of the LES and promote quick emptying of the stomach, another medicine such as cisapride may be used.
If drugs are not effective or the GER is severe, surgery may be needed. A fundoplication creates a valve mechanism by wrapping the upper part of the stomach (fundus) around the lower end of the esophagus. There are two types of fundoplication performed by our team. A Thal fundoplication is a partial wrap and a Nissen fundoplication is a total wrap. Your pediatric surgeon decides the type of fundoplication.
A gastrostomy feeding tube (GT) is often placed in the stomach when the fundoplication is performed. This tube is placed for feeding and for relief of gas bloat which is the most common side effect of a fundoplication. A child who has had GER could be underweight and may require extra nutrition through the GT. The gas bloat is due to the wrapping of the fundus which inhibits the child's ability to reflux and to "burp". With the GT in place, you can relieve your child's need to burp by opening the tube when your child is having gas bloat. Our pediatric surgery nurse or your child's nurse in the hospital will teach you how to use the GT. Our staff is always here to help you with any concerns that you may have.
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