GERD in Infants

Etiology: persistent lower esophageal sphincter insufficiency

Clinical features

• Poor appetite, refusal to feed, weight loss

• Failure to thrive

• Crying and irritability

• Abdominal distention, pain/discomfort

• Regurgitation, persistent vomiting

• Extraesophageal symptoms: wheezing, stridor, hoarseness, chronic cough

Diagnostics: based on clinical findings

• H&P (e.g., presence of red flags in GERD, nutritional assessment, cow's milk and/or soy protein intolerance)

• Imaging: may be indicated if symptoms after initiation of empirical treatment persist

  • Esophagogastroduodenoscopy with biopsies

  • Upper gastrointestinal imaging series (suspicion of anatomical abnormalities like malrotation or annular pancreas)

Conservative measures: lifestyle and dietary changes should be re-evaluated every 2–4 weeks

• Positioning therapy: maintain the infant in an upright position for 20–30 minutes after feeding

• If there is suspicion of cow's milk and/or soy protein intolerance:

  • Remove cow's milk or soy protein from the infant's diet

  • In breastfed infants, remove soy protein, cow's milk proteins, and beef from the mother's diet.

  • In formula-fed infants, substitute for a hypoallergenic formula

• Using food thickeners

• Avoid exposure to tobacco smoke

Pharmacological treatment

• 2–4 week trial with PPIs (e.g., esomeprazole), H2-receptor blockers (e.g., cimetidine)

• Indications

  • Infants with persistent significant symptoms (failure to thrive, feeding refusal, poor weight gain) and in which all conservative measures have failed

  • Esophagitis on endoscopic findings

Surgical treatment (complete or partial Nissen fundoplication): indicated in infants with complications from severe GERD who did not respond to conservative and pharmacological treatment