Gastro-esophageal reflux in neonatology

Abstract

Gastro-esophageal reflux (GER) is a near universal phenomenon in newborn infants. Regurgitation is so frequent that its complete absence may be considered as evidence of inadequate milk intake. GER occurs usually in association with transient relaxations of the lower esophageal sphincter, which may be triggered by entry of milk into the stomach, and is not associated with delayed gastric emptying. GER can be quantified using monitoring techniques which require prolonged presence of a foreign body in the esophagus. Either just pH (for possible complications related to acid exposure) monitoring or pH with multiple intraluminal impedance monitoring are available. Other investigations are rarely helpful. The definitions and diagnostic criteria of GER disease (GERD) are controversial and there is no consensus regarding which clinical signs may be caused by GER. In particular behavioural changes, feeding difficulties and significant apnea have not been clearly shown to be increased in infants with higher frequency of GER episodes, or to be temporally related to them. Prokinetic agents are ineffective. Anti-acid medications may effectively reduce gastric acid production, but have not been shown to improve clinical symptoms, and are associated with increased infectious risk, and may reduce the absorption of some micronutrients. In cases of acid related disease a therapeutic trial may be indicated if the benefits are thought to outweigh the risks. Reflux spontaneously improves over time in the preterm infant, but may be prolonged in those with surgical conditions such as esophageal atresia and diaphragmatic hernia.