GERD Flashcards
What are common gastrointestinal diseases associated with complex airway conditions in children?
Gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), dysphagia, disordered motility
These conditions often occur together in children with complex airway diseases.
What is the prevalence of GERD in children with complex medical conditions?
Up to 70%
Particularly in those with developmental delay or a history of tracheoesophageal fistula (TEF) repair.
Define gastroesophageal reflux (GER).
Inconsequential transient return of gastric contents into the esophagus lasting less than 3 minutes
Occurs in normal individuals and causes few or no symptoms.
What defines gastroesophageal reflux disease (GERD)?
Symptoms and/or mucosal changes related to excessive stomach acid regurgitation into the esophagus and oropharynx.
What are the potential causes of GERD in children?
- Altered thoracoabdominal pressure relationships
- Consequence of asthma symptoms or pulmonary disease
- Excess weight, sleep-disordered breathing, asthma interactions
These factors can lead to airway damage and respiratory issues.
List clinical features or symptoms of GERD.
- Reactive airway disease
- Chronic cough
- Hoarseness
- Difficulty swallowing
- Laryngeal edema
- Cobblestoning
- Mucosal erythema
True or False: Nonacid reflux is associated with chronic lung disease in adults.
True
What is the standard medical therapy for GERD?
Acid suppression
This typically involves the use of proton pump inhibitors (PPIs) or H2 blockers.
What are the risks associated with long-term use of proton pump inhibitors (PPIs)?
- Decreased bone density
- Increased risk for respiratory infections
- Increased risk for Clostridium difficile infection
What is eosinophilic esophagitis (EoE)?
An inflammation of the esophagus characterized by the presence of eosinophils
Specifically, >15 eosinophils/HPF of biopsies from the esophagus.
What are the key diagnostic criteria for EoE?
- Presence of >15 eosinophils/HPF in esophageal biopsies
- Absence of response to PPIs
- Absence of GERD or other eosinophilic inflammation-promoting conditions
What are common symptoms of EoE in younger children?
Feeding problems
Symptoms can vary by age, with older children experiencing dysphagia and food impaction.
List some common provocative antigens associated with EoE.
- Milk
- Soy
- Egg
- Seafood
- Nuts
- Wheat
What is the treatment approach for EoE?
- Elimination diet
- Topical steroids (fluticasone or budesonide)
- Nutritional support with amino acid-based formula
Fill in the blank: GERD is defined as symptoms or mucosal changes related to _______.
stomach acid regurgitation
What is the relationship between EoE and IgE-mediated food allergies?
The mechanism of immune response in EoE does not primarily involve IgE.
What is the significance of histologic changes in EoE?
Chronic persistent eosinophilic inflammation is associated with lamina propria fibrosis and reduced esophageal wall compliance.
What diagnostic procedure is required to confirm histologic remission in EoE?
Repeat endoscopy
Symptom resolution does not imply resolution of histologic inflammation.
What are the complications associated with fundoplication in GERD management?
- Gagging/retching
- Gas bloat
- Dumping syndrome
What is the role of endoscopic administration of Botox in managing gastric emptying disorders?
Provides temporary relief of symptoms
Often used in conjunction with pyloric dilatation.
What is the impact of esophageal dilatation in EoE management?
Can improve resulting dysphagia
Preferred along with diet or medical therapy to manage inflammation.
