Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Gastroesophageal reflux · Gastroesophageal reflux

disease · Regurgitation · Nutrition treatment · Food

allergy

Key Messages

• In infants, gastroesophageal reflux (GER) and re-
  gurgitation are most commonly self-resolving
  conditions that do not require treatment or ancil-
  lary testing


• GER disease (GERD) in infants may be indistinguish-
  able from milk protein allergy; therefore, if trouble-
  some symptoms persist in an infant, the possibility
  of allergy should be considered


• Assessment of nutritional status must be undertak-
  en concomitantly with the investigation and treat-
  ment of GERD in order to refrain from either subop-
  timal or excessive intake


• If prolonged medical treatment is deemed neces-
  sary, proton pump inhibitors are the treatment of
  choice, whereas conservative measures are ade-
  quate to treat mild GERD symptoms
  © 2015 S. Karger AG, Basel

Introduction

Gastroesophageal reflux (GER) is defined as the
passage of contents from the stomach into the
esophagus, and may be associated with regurgita-
tion or vomiting. GER is a common phenome-

non, especially in infants, and is considered a

physiologic occurrence [1]. If GER is associated

with troublesome signs or symptoms, however,

GER disease (GERD) is diagnosed, a condition

which may justify diagnostic or therapeutic inter-

ventions. Most cases of GER and GERD occur

without any predisposing factors, with reflux oc-

curring during transient lower esophageal sphinc-

ter relaxations (TLESR) [2, 3]. These relaxations

occur physiologically in all people, are more com-

mon after meals, in the sitting position, and fol-

lowing high-osmolarity meals. They allow the re-

lease of gases swallowed or produced in the stom-

ach; however, when TLESR is associated with the

efflux of food retrograde through the lower

esophageal sphincter, it produces GER. Almost

100% of GER and nonerosive GERD, and an esti-

mated 70% of erosive GERD, occur during TLESR

[4]. There are several predisposing factors which

increase the incidence of GER. These include a

dysfunctional lower esophageal sphincter (hiatal

hernia, after repair of esophageal atresia, after

Heller myotomy), increased intra-abdominal

pressure (peritoneal dialysis, abdominal mass),

cystic fibrosis, psychomotor delay, obesity, pre-

maturity and others. Several hormones, drugs

and nutrients have been implicated in influencing

tone of the lower esophageal sphincter, but the

clinical significance of most of these have not yet

been rigorously studied.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 203–208
DOI: 10.1159/000360341

3.12 Regurgitation and Gastroesophageal Reflux

Noam Zevit  Raanan Shamir

3