Management of Gastroesophageal reflux (GER)

Management of Gastroesophageal reflux (GER)

Treatment includes attempts at reducing entry of stomach contents into the esophagus and relieving symptoms.

1. Conservative management:

a. Positioning in an upright or sitting position or raising the head of the bed after

feedings or when asleep

b. Dietary recommendations include frequent small meals and thickening of feeds using infant cereal or a commercial thickener, which decrease the symptoms of GERD by making the stomach contents more viscous.

c. Medical Management:

d. Acid inhibition with antacids, histamine H2-blockers, and proton-pump inhibitors is effective in reducing the irritation caused by the refluxate.

2. Motility agents increase the LES tone or increase gastric emptying. The most commonly used agents are erythromycin or metoclopramide.

3. Surgery may be required for patients who fail conservative and medical management.

a. The Nissen fundoplication wraps the fundus of the stomach around the distal

3.5 cm of the esophagus, resulting in reduction of TLESR in as many as 90% of

children.

b. Pyloroplasty may be performed to improve gastric emptying.

c. Placement of a gastrostomy tube often accompanies a Nissen fundoplication in infants. Reduction in stomach volume by the Nissen procedure requires a period of adaptation and expansion of the stomach that is best assisted with tube feedings. A gastrostomy tube also enables venting of the stomach in cases of uncomfortable

bloating.