Gastroözefageal Reflü

ÖzGastroözefageal reflü (GÖR) yenidoğanlarda beslenmeden sonra sık görülen vegenellikle kendini sınırlandıran normal bir fizyolojik süreçtir. Gastroözefageal reflü hastalığı (GÖRH) ise yetersiz kilo artışı, huzursuzluk, sık tekrarlayan kusma, özefajit, persiste eden solunum sistemi bulguları ve diğer komplikasyonların eşlik ettiği patolojik bir durumdur. Tedavide öncelikle konservatif yaklaşımlar (yaşam şekli değişiklikleri, kıvamlı beslenme, beslenme sonrası yatış pozisyonları, maternal beslenmeden süt, soya gibi öğelerin çıkarılması, sigaraya maruziyetten korunma) denen-melidir. Birçok hastada ileri tetkike ve farmakolojik tedavi unsurlarına gerek duyulmamaktadır. Transplorik beslenme ve cerrahi tedaviye nadiren başvurulur. Bu derleme yazısında GÖR ve GÖRH’nin yenidoğan dönemindeki klinik bulgu, patofizyoloji, tanı ve tedavisinin güncel bilgiler eşliğinde tartışılması amaçlandı.

Gastroesophageal Reflux

AbstractGastroesophageal reflux (GER) is common in infants. Generally GER is a normal self limitted physiologic process that occurs time to particularly after feedings.Gastroesophageal reflux disease (GERD) is a pathologic condition in infants manifested by irritability, frequent bouts of emesis, poor weight gain, signs of esophagitis, persistent respiratory symptoms and other complications. Conservative management (lifestyle changes, thickened feedings, positioning therapy, limitation of milkand soy foods from a mother's diet, avoid exposing the infant to tobacco smoke) should be tried primarily. Most patients do not require further investigation and pharmacoterapy. Transpyloric feeding and antireflux operations are rarely indicated. Thepurpose this review is to discuss the latest controversies with respect to clinical ma-nifestations, diagnosis, pathophysiology, diagnosis and treatment of GER and GERD in newborn and infants.

___

  • Kaynaklar 1.Jon A. Vanderhoof JA, Pauley-Hunter RJ. Gastrointestinal di-sease. MacDonald MG, Seshia MMK (eds). Avery’s Neona-tology Pathophysiology and Management of the Newborn, 7thed. Philadelphia: Wolters Kluwer, 2016: 719-39. 2.Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, LiptakG, Mazur L, et al. North American Society for Pediatric Gas-troenterology Hepatology and Nutrition, European Society forPediatric Gastroenterology Hepatology and Nutrition. Pedi-atric gastroesophageal reflux clinical practice guidelines: jo-int recommendations of the North American Society for Pe-diatric Gastroenterology, Hepatology, and Nutrition (NASPG-HAN) and the European Society for Pediatric Gastroentero-logy, Hepatology, and Nutrition (ESPGHAN). J PediatrGastroenterol Nutr. 2009;49(4):498-547. 3. Lightdale JR, Gremse DA; Section on Gastroenterology, He-patology, and Nutrition. Gastroesophageal reflux: manage-ment guidance for the pediatrician. Pediatrics. 2013;131(5):e1684-95. 4.Herbst JJ. Gastroesophageal reflux in infants. J Pediatr Gas-troenterol Nutr. 1985;4:163. 5.Vandenplas Y, Goyvaerts H, Helven R, Sacre L. Gastroesop-hageal reflux, as measured by 24-hour pH monitoring, in 509healthy infants screened for risk of sudden infant death syndro-me. Pediatrics. 1991; 88:834-40. 6.Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalen-ce of symptoms of gastroesophageal reflux during childhood:a pediatric practice-based survey. Pediatric Practice ResearchGroup. Arch Pediatr Adolesc Med. 2000;154(2):150-4. 7.Campanozzi A, Boccia G, Pensabene L, Panetta F, Marseg-lia A, Strisciuglio P, et al. Prevalence and natural history ofgastroesophageal reflux: pediatric prospective survey. Pedi-atrics. 2009;123(3):779-83. 8.Martin AJ, Pratt N, Kennedy JD, Ryan P, Ruffin RE, Miles H,et al. Natural history and familial relationships of infant spil-ling to 9 years of age. Pediatrics. 2002;109(6):1061-7. 9.Sherman PM, Hassall E, Fagundes-Neto U, Gold BD, KatoS, Koletzko S, et al. A global, evidence-based consensus on thedefinition of gastroesophageal reflux disease in the pediatricpopulation. Arch Pediatr. 2010;17(11):1586-93. 10.Novak DA. Gastroesophageal reflux in the prematüre infant.Clin Perinatol. 1996;23(2):305-20. 11.Rosen R. Gastroesophageal Reflux in Infants More than Justa pHenomenon. JAMA Pediatrics. 2014;168(1):83-9. 12.Omari TI, Barnett CP, Benninga MA, Lontis R, Goodchild L,Haslam RR, et al. Mechanisms of gastro-oesophageal refluxin prematüre and term infants with reflux disease. Gut.2002;51(4):475-9. 13.Novak DA. Gastroesophageal reflux in the prematüre infant.Clin Perinatol. 1996;23:305-20. 14.Pensabene L, Miele E, Del Giudice E, Strisciuglio C, Staia-no A. Mechanisms of gastroesophageal reflux in children withsequelae of birth asphyxia. Brain Dev. 2008;30(9):563-71. 15.Moroz SP, Espinoza J, Cumming WA, Diamant NE. Loweresophageal sphincter function in children with and without gas-troesophageal reflux. Gastroenterology. 1976;71(2):236-41. 16.Davidson G. The role of lower esophageal sphincter functi-on and dysmotility in gastroesophageal reflux in prematureinfants and in the first year of life. J Pediatr Gastroenterol Nutr.2003; 37 Suppl 1:S17. 17.Staiano A, Boccia G, Salvia G, Zappulli D, Clouse RE. De-velopment of esophageal peristalsis in prematüre and term neo-nates. Gastroenterology. 2007;132(5):1718-25. 18.Kawahara H, Dent J, Davidson G, Okada A. Relationship bet-ween straining, transient lower esophageal sphincter relaxa-tion, and gastroesophageal reflux in children. Am J Gastro-enterol. 2001;96(7):2019-25. 19.Slocum C, Arko M, Di Fiore J, Martin RJ, Hibbs AM. Apnea,bradycardia and desaturation in prematüre infants before andafter feeding. J Perinatol. 2009;29(3):209-12. 20.Di Fiore JM, Arko M, Whitehouse M, Kimball A, Martin RJ.Apnea is not prolonged by acid gastroesophageal reflux in pre-matüre infants. Pediatrics. 2005;116(5):1059-63. 21.Leape LL, Holder TM, Franklin JD, Amoury RA, Ashcraft KW.Respiratory arrest in infants secondary to gastroesophagealreflux. Pediatrics. 1977;60(6):924-8. 22.Omari TI. Apnea-associated reduction in lower esophageal sphincter tone in premature infants. J Pediatr. 2009;154(3):374-8. 23.Salvatore S, Hauser B, Vandemaele K, Novario R, VandenplasY. Gastroesophageal reflux disease in infants: how much is pre-dictable with questionnaires, pH-metry, endoscopy and histo-logy? J Pediatr Gastroenterol Nutr. 2005;40(2):210-5. 24.Farhath S, He Z, Nakhla T, Saslow J, Soundar S, Camacho J,et al. Pepsin, a marker of gastric contents, is increased in trac-heal aspirates from prematüre infants who develop broncho-pulmonary dysplasia. Pediatrics. 2008;121(2):e253-9. 25.Akinola E, Rosenkrantz TS, Pappagallo M, McKay K, Hus-sain N. Gastroesophageal reflux in infants < 32 weeks gesta-tional age at birth: lack of relationship to chronic lung disea-se. Am J Perinatol. 2004;21(2):57-62. 26.Frakaloss G, Burke G, Sanders MR. Impact of gastroesopha-geal reflux on growth and hospital stay in premature infants.J Pediatr Gastroenterol Nutr. 1998;26(2):146-50. 27.Coletti RB, Christie DL, Orenstein SR. Statement of the NorthAmerican Society for Pediatric Gastroenterology and Nutri-tion (NASPGN). Indications for pediatric esophageal pH mo-nitoring. J Pediatr Gastroenterol Nutr. 1995;21(3):253-62. 28.Vandenplas Y, Franckx-Goossens A, Pipeleers-Marichal M,Derde MP, Sacré-Smits L. Area under pH 4: advantages ofa new parameter in the interpretation of esophageal pH mo-nitoring data in infants. J Pediatr Gastroenterol Nutr.1989;9(1):34-9. 29.Vandenplas Y, Badriul H, Verghote M, Hauser B, KaufmanL. Oesophageal pH monitoring and reflux oesophagitis in ir-ritable infants. Eur J Pediatr. 2004;163(6):300-4. 30.Loots CM, Benninga MA, Davidson GP, Omari TI. Additionof pH-impedance monitoring to standard pH monitoring in-creases the yield of symptom association analysis in infantsand children with gastroesophageal reflux. J Pediatr.2009;154(2):248-52. 31.Hassall E. Decisions in diagnosing and managing chronic gas-troesophageal reflux disease in children. J Pediatr. 2005;146(3Suppl):S3-12. 32.Salvatore S, Vandenplas Y. Gastroesophageal reflux and cowmilk allergy: is there a link? Pediatrics. 2002;110(5):972-84. 33.Orenstein SR, Whitington PF, Orenstein DM. The infant seatas treatment for gastroesophageal reflux. N Engl J Med.1983;309(13):760-3. 34.Loots C, Kritas S, van Wijk M, McCall L, Peeters L, Lewin-don P, et al. Body positioning and medical therapy for infan-tile gastroesophageal reflux symptoms. J Pediatr Gastroen-terol Nutr. 2014;59(2):237-43. 35.Orenstein SR, McGowan JD. Efficacy of conservative therapyas taught in the primary care setting for symptoms suggestinginfant gastroesophageal reflux. J Pediatr. 2008;152(3):310-4. 36.Jung WJ, Yang HJ, Min TK, Jeon YH, Lee HW, Lee JS, et al.The efficacy of the upright position on gastro-esophageal ref-lux and reflux-related respiratory symptoms in infants withchronic respiratory symptoms. Allergy Asthma Immunol Res.2012;4(1):17-23. 37.Heacock HJ, Jeffery HE, Baker JL, Page M. Influence of bre-ast versus Formula milk on physiological gastroesophagealreflux in healthy, newborn infants. J Pediatr Gastroenterol Nutr.1992;14(1):41-6. 38.Cavatio F, Iacono G, Montalto G, Soresi M, Tumminello M,Campagna P, et al. Gastroesophageal reflux associatedwith cow's milk allergy in infants: which diagnostic examina-tions are useful? Am J Gastroenterol. 1996;91(6):1215-20. 39.Craig WR, Hanlon-Dearman A, Sinclair C, Taback S, Mof-fatt M. Metoclopramide, thickened feedings, and positioningfor gastro-oesophageal reflux in children under two years.Cochrane Database Syst Rev. 2004;(4):CD003502. 40.Hojsak I, Braegger C, Bronsky J, Campoy C, Colomb V, Dec-si T, et al.; ESPGHAN Committee on Nutrition. Arsenic in rice:a cause for concern. J Pediatr Gastroenterol Nutr.2015;60(1):142-5. 41.Omari TI, Barnett CP, Benninga MA, Lontis R, Goodchild L,Haslam RR, et al. Mechanisms of gastro-oesophageal refluxin prematüre and term infants with reflux disease. Gut.2002;51(4):475-9. 42.Malcolm WF, Cotten CM. Metoclopramide, H2 blockers, andproton pump inhibitors: pharmacotherapy for gastroesopha-geal reflux in neonates. Clin Perinatol. 2012;39(1):99-109. 43.Tighe M, Afzal NA, Bevan A, Hayen A, Munro A, Beattie RM.Pharmacological treatment of children with gastro-oesopha-geal reflux. Cochrane Database Syst Rev. 2014;11:CD008550. 44.Boyle JT. Acid secretion from birth to adulthood. J Pediatr Gas-troenterol Nutr. 2003;37 Suppl 1:S12-6. 45.Higginbotham TW. Effectiveness and safety of proton pumpinhibitors in infantile gastroesophageal reflux disease. AnnPharmacother. 2010;44(3):572-6. 46.Moore DJ, Tao BS, Lines DR, Hirte C, Heddle ML, DavidsonGP. Double-blind placebo-controlled trial of omeprazole inirritable infants with gastroesophageal reflux. J Pediatr.2003;143(2):219-23. 47.Higginbotham TW. Effectiveness and safety of proton pumpinhibitors in infantile gastroesophageal reflux disease. AnnPharmacother. 2010;44(3):572-6. 48.Ummarino D, Miele E, Martinelli M, Scarpato E, Crocetto F,Sciorio E, et al. Effect of magnesium alginate plus simethico-ne on gastroesophageal reflux in infants. J Pediatr Gastro-enterol Nutr. 2015;60(2):230-5. 49.McAteer J, Larison C, LaRiviere C, Garrison MM, Goldin AB.Antireflux procedures for gastroesophageal reflux disease inchildren: influence of patient age on surgical management.JAMA Surg. 2014;149(1):56-62. 50.Malcolm WF, Smith PB, Mears S, Goldberg RN, Cotten CM.Transpyloric tube feeding in very low birthweight infants withsuspected gastroesophageal reflux: impact on apnea and brady-cardia. J Perinatol. 2009;29(5):372-5.