Digestive Disorder
07 May 2019
WHAT IS GASTROESOPHAGEAL REFLUX?
It happens when part of ingested liquid, food or gas inside the stomach inadvertently reverses backward and enters the lower esophagus instead of completely empties into the small bowel. This is a result of transient relaxation of the lower esophageal sphincter that is made up of muscle fibres that when it constricts, it shuts down communication between the stomach and the esophagus preventing this phenomenon from happening.
This frequently occurs in young infants where this sphincter has yet to achieve its fully coordinated function hence, the term physiological reflux ie. relaxes to allow ingested food or liquid to pass through into the stomach and constricts to prevent reversal of flow (refer image). In some proportion of infants, reflux occurs following over feeding as the stomach cannot accommodate excess amount hence some of it force itself out through the sphincter.
WHAT ARE THE SYMPTOMS?
Infants could present with repeated episodes of milk regurgitation during feeding or after feeding. It is typically an effortless regurgitation that makes it different from vomiting where it is more of a forceful expulsion. The affected infants commonly would remain well and happy despite having multiple episodes a day.
Occasionally, reflux could be severe enough to cause regurgitation of blood stained liquid. This usually indicates injury to the lining of the esophagus as a result of repeated contact with the stomach content that is often acidic. This may also be associated with unexplained irritability, crying bouts, abnormal posturing due to pain as the acidic stomach content comes in contact with the already injured lining of the esophagus. The affected infants may also develop anaemia due to repeated blood loss from the injured lining. Poor weight gain may also be observed in infants who have feeding difficulties as a result of above complications.
IS IT NECESSARY TO CONSULT A DOCTOR?
The answer is yes. A complete assessment would be able to ensure that your infants are only having physiological reflux, a common condition that may be part of normal maturation of the intestinal tract.
HOW IS THIS CONDITION TREATED?
For physiological reflux, the tips below are helpful:
- Elevate head at about 45 degrees during feeding and up to 30 minutes after feeding as the gravity force would help to keep the stomach content where it should be.
- Do not overfeed. Your regular doctor would be able to give you a rough estimate how much milk your baby would need in a day. Overfeeding rarely occurs in breastfed infants as they would stop sucking from the breast once contented.
- Avoid using tight clothing particularly those with elastic band as this would create additional pressure to the stomach that may potentiate reflux episodes.
- Breastfeeding is the best as breast milk has properties that stimulate rapid clearance of stomach content that brings about reduction of reflux episodes and as mentioned earlier, breastfed infants rarely overfeed.
- For formula fed infants, a change to AR (anti regurgitation) formula may also be helpful.
For complicated cases, the infants invariably would need medical treatment. Formula fed infants who do not improve with medical treatment may benefit from therapeutic trial of cow’s milk exclusion as there has been growing evidence to link development of reflux with cow’s milk protein allergy. Further investigations like 24 hour pH monitoring, radiological imaging or endoscopic evaluation may also be necessary.
WHAT IS THE LONG TERM OUTLOOK?
The general outlook is excellent. Infants with physiological reflux usually outgrow the problem by the time they are one-year-old. However, infants with complicated reflux may take longer time to recover.
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