gastroesophageal reflux

Gastroesophageal reflux is a common problem in humans; the term means that stomach contents, which are supposed to flow on down the GI tract, are refluxing, or flowing backward up into the esophagus.

We have always recognised that it is quite common in children; after all, baby spitting is nothing but reflux, and as Forrrest Gump might say, "Spit happens." But now we recognise that reflux, especially with associated reflux esophagitis, is the cause of a number of previously mysterious conditions. Among these are the pseudo-colicy symptoms of reflux esophagitis, persistent night cough syndromes, intractable "asthma," recurrent pneumonias, and chest pain.

A misconception exists about reflux and spitting up in small children. Some will say, "This cannot be reflux, because the baby does not spit up." This confuses spitting, which means the leakage from the stomach travelled all the way to the mouth and spurted out, to reflux in general, which may mean that the leakage only went part way up the esophagus. It is those babies - in whom not only does the refluxed material not always reach the mouth, but in whom the material is mainly stomach acid undiluted by milk - who have symptomatic gastroesophageal reflux, due to reflux esophagitis, caused by literal burning of the esophagus.

A review1 of available scientific studies finds that the traditional methods of dealing with gastroesophageal reflux are not proved to work. In light of these findings, the authors advise caution in using these interventions that really are not shown convincingly to work. The reviewers only found ten studies out of 35 that they reviewed which met their criteria for scientific validity of the results.

  • Two studies showed that neither positioning babies upright in an infant seat, nor elevating the head of the crib reduced reflux
  • Thickened formula did not significantly reduce reflux as measured by acid-monitoring pH probes, but did somewhat reduce outright vomiting; carob bean gum was significantly more successful in reducing reflux than adding rice flour
  • No good study evaluated whether smaller feeding volumes or more frequent feedings helped reduce reflux
  • There was no evidence pacifier use had anything to do with reflux, and formula changes were not shown to be beneficial

The authors cautioned that while the studies did not prove the therapies work, they also did not prove they do not work. But without more convincing evidence of efficacy, it is wise not to push potentially interventions that may cause more trouble for child and parents than beneficial effects. They reminded that "Nearly all cases will get better without any therapy at all... If the problem is severe, other treatments besides the ones we studied should be considered."

Medical (and sometimes even surgical) treatment is available for reflux and especially reflux esophagitis. Let happy spitters spit - they will grow out of it. Let unhappy refluxers be treated with the best that medicine has to offer; they can be helped.

1. Archives of Pediatric and Adolescent Medicine 2002;156:109-113.

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