Gastroesophageal Reflux Disorder: Difficulties in Diagnosis and Treatment in Infants

Abstract

Gastroesophageal Reflux Disease (GERD), as the name suggests, is  a  condition  wherein  there  is  a reflux of the contents of the stomach towards the oesophagus, which eventually leads to pathological changes in the oesophagus itself if not managed at an early stage appropriately. Here we present a case of a 6 month old infant who presented with a history of repeated cough, fever, difficulty in breathing and poor weight gain. Various  physicians  saw  the  infant,  however,  due  to  worsening  symptoms  and no relief, the infant presented to the paediatric emergency department of the  Abbasi  Shaheed  Hospital. An initial management for pneumonia was done  but  there  was  a  persistence  of  symptoms even after clearance of the pneumonic patch. An upper gastrointestinal (GI) imaging  study,  including Barium swallow and fluoroscopy was done to evaluate the anatomy of the upper gastrointestinal tract    which showed mild to moderate reflux but no strictures, stenosis, achalasia or gastric outlet obstruction. The infant was managed via medical intervention and lifestyle counselling. On follow-up, the infant improved clinically and gained weight. It is extremely important in such  cases  to  have  a  strong clinical suspicion of Gastroesophageal reflux (GER) which may lead to GERD, while assessing  the  patient's signs and symptoms and to  support  the  diagnosis  of  GERD  with  appropriate  investigations and management.