Dr.

Faisal
Al-Haffaf
Contents

 GERD

 TEF
 EOE
 Question
• Question 1: What is the definition of GER/GERD?

• Question 2: What are the “red flag” ??

• Question 3: What diagnostic interventions? barium contrast, ultrasonography, SCOPE, scintigraphy?

• Question 4: What is the non-pharmacologic treatment options ?

• Question 5: What are effective and safe pharmacologic treatment ?

• Question 6: Which infants and children would benefit from fundoplication?

 Defenitions

• GER: the passage of gastric contents into the esophagus with or without regurgitation and vomiting.

• GERD: when GER leads to troublesome symptoms and/or complications.

• Refractory GERD: GERD not responding to optimal treatment after 8 weeks.

 Defenitions
• Regurgitation: the passage of refluxed contents into the pharynx, mouth or mouth.

• Other terms such as ‘spitting-up’, ‘posseting’, and ‘spilling’ are considered equivalent to regurgitation.

• Vomiting: a coordinated autonomic and voluntary motor response, causing forceful expulsion of gastric
contents through the mouth.

• Rumination: effortless regurgitation of recently ingested food into the mouth With subsequent mastication
and reswallowing.
 DO NOT
• DO NOT use barium contrast studies for the diagnosis of GERD.
barium contrast studies to exclude anatomical abnormalities.

• DO NOT to use ultrasonography for the diagnosis of GERD.

use ultrasonography to exclude anatomical abnormalities.

• DO NOT use SCOPE to diagnose GERD.

use esophago-gastro-duodenoscopy with biopsies to assess complications of GERD, in case an
underlying mucosal disease is suspected and prior to escalation of therapy.
 DO NOT
• DO NOT use manometry for the diagnosis of GERD in infants and children.
use manometry when a motility disorder is suspected.

• DO NOT use scintigraphy for the diagnosis of GERD in infants and children.

• DO NOT use transpyloric/jejunal feeding trials for the diagnosis of GERD in infants and children.
consider the use of transpyloric/jejunal feedings in the treatment of infants and children with
GERD refractory to optimal treatment as an alternative of fundoplication.
 Treatment
• PPIs as first-line treatment of GERD, use H2RAs if PPIs are not available or contra-indicated.

• consider the use of baclofen prior to surgery in whom other medical therapy have failed.

• DO NOT use domperidone, metoclopramide or prokinetic.

• consider antireflux surgery, including fundoplication: life threatening complications (apneas or

BRUE) or refractory symptom safter failure of optimal medical treatment.

• consider to use total esophagogastric disconnection as a rescue procedure for

• neurologically impaired children with a failed fundoplication
 Question
• Question 1: What is the definition of GER/GERD?

• Question 2: What are the “red flag” ??

• Question 3: What diagnostic interventions? barium contrast, ultrasonography, SCOPE, scintigraphy?

• Question 4: What non-pharmacologic treatment options ?

• Question 5: What are effective and safe pharmacologic treatment ?

• Question 6: Which infants and children would benefit from fundoplication?

 TEF

• ASSOCIATION: VACTERL, CHARGE, ….

• COMPLICATION: LEAKAGE, TRACHEOMALACIA, GERD
 Eosinophilic Esophagitis
• Eosinophilic esophagitis (EoE) is a chronic immune/antigenmediated esophageal inflammatory disease
associated with esophageal dysfunction.

≥ 15 eos/hpf

Infants and toddlers develop nonspecific symptoms with feeding difficulties (including vomiting, regurgitatio
n and feeding refusal), which can result in failure to thrive.

During childhood, vomiting and/or abdominal or retrosternal pain are reported, whereas during adolescence,
gastroesophageal reflux disease (GERD) symptoms, dysphagia, and food impaction are the most frequent
Symptoms.

• Atopy.
treatment
Thank You