Gastro-esophageal reflux is a disease primarily characterized by the frequent and recurrent backflow of stomach contents into the esophagus, caused by various factors leading to dysfunction in gastro-esophageal motility. From an etiological perspective, it can be classified into physiological and pathological types. Physiological reflux mainly results from relaxation of the lower esophageal sphincter (LES) and tends to resolve naturally. However, a small portion of cases are caused by congenital defects in the esophageal sphincter, abnormal digestive endocrine function, or congenital anatomical deformities in the lower esophagus or gastric cardia (such as diaphragmatic hernia). These cases often do not resolve spontaneously and fall under the pathological category. Most of these patients exhibit significant complications.

bubble_chart Clinical Manifestations

1. Neonatal and infant gastroesophageal reflux: Mainly manifests as recurrent vomiting, with vomitus primarily consisting of food, about one-third of which contains bile, indicating concurrent duodenal regurgitation. It usually resolves naturally before the age of 2 but can also lead to complications such as malnutrition, aspiration pneumonia, and sudden nocturnal asthma-like bronchospasm. In newborns, it often presents as recurrent cyanosis, apnea, or even sudden death. A small number of children may not show improvement after the age of 2, which can then be considered pathological gastroesophageal reflux.
2. Since the reflux contains gastric enzymes and pepsin, children may experience esophageal burning sensations during reflux, mostly occurring at night when lying flat. With large reflux volumes, the child may suddenly wake up choking or coughing, and in some cases, it may trigger bronchial asthma. Repeated reflux and aspiration can lead to chronic lung inflammation or even pulmonary fibrosis. Acidic reflux can cause multiple severe dental caries. The most typical complication is reflux esophagitis due to prolonged corrosion, followed by peptic esophageal ulcers, which may progress to esophageal stricture. At this stage, the child may complain of retrosternal burning pain and dysphagia during meals.
3. Chronic iron-deficiency anemia: Due to long-term blood loss from esophageal ulcers, some patients present with chronic iron-deficiency anemia, and a few may seek medical attention with this as their sole complaint. Most patients test positive for fecal occult blood, and some may experience hematemesis or melena, especially when combined with hiatal hernia, where bleeding becomes more pronounced. Some patients may develop moderate to grade III anemia.

bubble_chart Auxiliary Examination

1. 24-hour esophageal pH monitoring: Currently, a lower esophageal pH electrode is used for 24-hour monitoring. A pH below 4 indicates reflux.
2. Fiber-optic esophagoscopy: This can simultaneously measure acidity, observe any lesions, and allow for pathological examination.
3. Blood and stool routine tests: May reveal varying degrees of microcytic hypochromic anemia, with decreased serum ferritin levels. Stool tests may show occult blood positivity.
4. X-ray examination: After fasting, a barium meal is administered, and X-ray imaging is used to observe the presence of barium reflux, assess the degree of reflux, evaluate esophageal motility, check for strictures, and examine the anatomical conditions of the gastroesophageal region, such as the His angle and the presence of hiatal hernia.

bubble_chart Treatment Measures

1. Proper positioning and dietary therapeutics: Effective for most physiological cases in children, often adopting an inclined sleeping position with a high side elevation of 30° to 60° in the prone position. Avoid eating within 2 hours before bedtime. Small, frequent meals are recommended, with a focus on thick, dense foods.
2. Drug therapy: Currently, the main approach involves a combination of prokinetic agents and antacids. Prokinetic agents commonly used include domperidone, with a dose of 0.3mg/kg, taken 15–30 minutes before meals, though an appropriate dose for newborns has not been established. Metoclopramide can also accelerate gastric emptying but is rarely used due to the high risk of extrapyramidal reactions. Cisapride is now more commonly used, with a dose of 0.3mg/kg three times daily for children and 0.15–0.20mg/kg three times daily for infants, proving more effective than domperidone. Antacids currently in use are mainly H2 receptor antagonists, such as cimetidine or ranitidine, or proton pump inhibitors like omeprazole. Iron supplements should be administered for cases with anemia.
3. Surgical treatment: If medical treatment fails after 6 weeks, and symptoms such as recurrent pneumonia, severe esophagitis, esophageal stricture, malnutrition, refractory anemia, or recurrent significant bleeding or hiatal hernia are present, surgical intervention should be considered. The Nissen fundoplication is currently the preferred method, with an efficacy rate of up to 95%.