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Gastroesophageal Reflux Disease GERD in Kids Ceu
Gastroesophageal Reflux Disease GERD in Kids Ceu
Reflux Disease
(GERD)
In The Child
Abstract
Policy Statement
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requirements of the American Nurses Credentialing Center's Commission on
Accreditation for registered nurses. It is the policy of NurseCe4Less.com to
ensure objectivity, transparency, and best practice in clinical education for
all continuing nursing education (CNE) activities.
This educational activity is credited for 2 hours. Nurses may only claim credit
commensurate with the credit awarded for completion of this course activity.
Course Purpose
Elizabeth Boldon, RN, MSN, William S. Cook, PhD, Douglas Lawrence, MA,
What Is GERD?
Preschool
The best diagnostic option for children remains a topic of debate. The Rome
Foundation, discussed later, researches and reviews patient care outcome
data to help guide clinician’s to make a rational decision.
Screening Questionnaires
Empiric Treatment
Barium studies of the esophagus are neither sensitive nor specific for the
diagnosis of GERD. Thus, radiologic evaluation is not useful to confirm or
exclude GERD in children. However, it can be useful in the evaluation of
selected patients with atypical or severe presenting features, particularly
those with dysphagia or odynophagia. In such patients, the barium contrast
study is used to evaluate for the possibility of anatomic abnormalities,
including hiatal hernia, achalasia, tracheoesophageal fistula, anastomotic
strictures, antral web, intestinal malrotation, or peptic strictures.4
The test involves passing a catheter through the nose into the lower
esophagus, where pH is continuously measured by a microelectrode. The pH
electrode is positioned according to a formula that takes into account the
length of the child. Radiologic or manometric confirmation of the position of
the tip of the probe usually is not necessary. A device is worn by the patient
and records esophageal acid exposure during the period of monitoring. The
procedure is considered to be very safe, but keeping the probe in place may
be difficult in toddlers and uncooperative children.
Newer pH study devices that clip a capsule to the esophageal mucosa and
remain in place for 24 – 48 hours allow recording of intraesophageal pH
without the transnasal catheter. This technology can be used for older
children and is particularly beneficial for children with autism in whom
transnasal pH monitoring studies may be difficult to perform.
Respiratory Problems
A child or teen with GERD might breathe stomach acid into his or her lungs.
The stomach acid can then irritate the throat and lungs, causing respiratory
problems or symptoms, such as:
Infants:
Keeping the child upright for at least two hours after eating
Serving several small meals throughout the day, rather than three
large meals
Limiting foods and beverages that seem to worsen the child's reflux
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)
Antacids
Prokinetics
Surface Agents
Sodium alginate, which is derived from seaweed, forms a surface gel that
creates a physical barrier against regurgitation of gastric contents and
protects the esophageal mucosa. Studies comparing its efficacy on
symptoms and esophageal acid exposure with other available treatments
have produced conflicting results. It currently is used infrequently in the
treatment of children with GERD.4
The Nissen fundoplication is the most often performed surgery. During this
procedure, the top part of the stomach is wrapped around the esophagus
forming a cuff that contracts and closes off the esophagus whenever the
stomach contracts - preventing reflux. The procedure is usually effective, but
it is not without risk. Potential risks and benefits of this operation should be
discussed with health care providers before it is performed.
Endoscopic Techniques
Summary
15. Baclofen
a. a gamma-amino-butyric acid A (GABA-A) receptor agonist
b. inhibits transient relaxations of the lower esophageal sphincter
c. reduces reflux symptoms for only chronic conditions
d. slows gastric emptying
11. Many of the children who have undergone antireflux surgery have
15. Baclofen