- 1-800-248-1199
Diseases of the Upper GI Tract
Diseases of the Upper GI tract: IntroductionA. What is GERD? The Division of Pediatric Gastroenterology provides expert knowledge and care in the diagnosis and treatment of diseases of the upper GI tract that include gastroesophageal reflux disease (GERD), allergic eosinophilic esophagitis (AEE), Barrett's esophagus, ulcers, H. pylori infection, celiac disease and other disease processes. We provide access to care from multi-disciplinary specialists including pediatric gastroenterologists, pediatric surgeons, pediatric GI nurses, pediatric dieticians, and pediatric social workers. What is GERD?
GER and GERD are common conditions. GER often occurs in infants and babies who may be "happy spitters". GERD is seen in all ages, and adults experiencing "heartburn" may actually be suffering from GERD. In infants, common symptoms of this condition include vomiting, regurgitation, coughing, and irritability. It is, however, important to remember that it is generally not worrisome for infants to have episodes of spitting up as long as they are not suffering from complications such as poor weight gain, excessive irritability or discomfort, breathing problems (such as choking/aspirating food into the airway, cyanosis [turning blue] or wheezing), seizures etc. Most infants grow out of GER by the age of 12 to 18 months; improvement may be noted when the infant starts to sit, stand or walk. It is, however, not normal for toddlers, older children or adolescents to vomit. In these age groups, children with GER/GERD may have refusal to feed, vomiting, abdominal pain, chest pain, heartburn, or sensation of food getting stuck in the food pipe. Older patients may also describe a sour taste or acidic sensation in the back of their throat. Presence of these symptoms warrants additional evaluation. How do I find out if my child had GERD?In addition to a complete history from you and the child, and a thorough physical examination of the child, your physician may perform tests. Tests may be needed to evaluate for GER and GERD, to assess the severity of the problem, and to establish associated complications. A variety of tests may be discussed by your physician, and include: Upper Gastrointestinal barium x-ray ("Upper GI")This test will show the size and shape (known as the "anatomy") of the upper GI tract through x-ray images. It will allow the doctor to see if any obstruction or structural problems may be the cause of these symptoms. Before the test, the child will not be able to have anything to eat or drink. This could be up to 8 hours before the test is scheduled, depending on the age of the child. When the child arrives for the test in the X-ray area (known as "Radiology") of the hospital, he/she will be given a white liquid, called "barium", to drink. This liquid will coat the GI tract and outline the esophagus, stomach and small intestines. If the child is not able to, or refuses to, drink the barium, a tube may be placed through the nose into the esophagus, and the barium will be given through the tube. Gastric Scintiscan or gastric emptying studyThis test helps evaluate for emptying of the stomach and may also provide information on the presence of reflux from the stomach to the esophagus. This test is done in the nuclear medicine area of Radiology and is an outpatient test (that is, the child does not need to be admitted to the hospital for the test). The child is fed a tasteless dye mixed with milk/formula/food. It is important for the child not to have anything to eat or drink for up to eight hours before the test to ensure that the stomach will be empty at the time the test is started.
Upper GI endoscopy (EGD)This test allows the physician to examine the lining of the esophagus, stomach and duodenum (first part of small bowel) using a camera in a flexible tube (called an endoscope). The procedure is done in the operating room under general anesthesia so that the child will not feel any pain. The physician will pass the endoscope through the child's mouth and examine the esophagus, stomach, and the duodenum. After examining the upper GI tract, the physician will collect biopsies, which will be sent to a pathologist to examine under a microscope for inflammation and other signs of disease. Biopsies are very small pieces of the tissue lining and should not cause any discomfort to the child. The physician will talk with you and the child before the procedure and answer your questions. Some children may get a medication to help them relax before being taken to the operating room area. After the procedure, the child will be taken to the recovery room, allowed to fully awaken, and then brought out to you. The physician will discuss the preliminary findings of the procedure and show pictures taken during the procedure. The child will be discharged home in a couple of hours after the procedure; it will be ensured that the child is fully awake and able to drink liquids before being discharged home. The total time spent at the hospital will depend on the testing and the time for the child to wake up. It is best to expect to spend 4-5 hours at the hospital. Esophageal pH probeFor this test, a small plastic tube will be passed through the nose and into the esophagus. At the end of this tube, there are sensors that detect acid reflux and will be positioned at specific spots along the esophagus. Placing the tube only takes a few minutes and can be done in clinic without sedation. Some children may have the pH probe placed in the operating room under general anesthesia if the test is done in coordination with Upper GI endoscopy (see above). Once the tube is positioned, it is securely taped to the child's face. This probe will remain in place for 24-26 hours and record the occurrence of acid reflux on a small recorder worn by the child. For young children, soft arm restraints may be placed to avoid having the child pull the probe out of his/her nose. The child is sent home with the probe and is allowed to eat and drink with the tube in place. During the study, it is important for the child to have a normal activity and schedule as much as possible so as to get an accurate reading. There will be some additional instructions for the recording device that will be explained at the time of the procedure; you will also need to maintain a diary which will be explained to you. The child will return to the hospital the next day to have the probe pulled out. Bravo pH studyThis test is similar to the esophageal pH probe except this test uses a small capsule rather than a long tube and is only done in the operating room in conjunction with an Upper GI endoscopy. The capsule is attached to the lining of the esophageal wall and sends data on acid reflux, by wireless technique, to a small recorder that the child will wear. The recording lasts for 48 hours and you will need to bring back the recorder to our office. The capsule will fall off of the esophagus after a few days and pass out in stool ? you should not try to retrieve the capsule from the stool! If you have not seen the capsule pass after two weeks, the physician may obtain a chest x-ray to ensure that the capsule has detached from the esophagus. The advantages of the Bravo test over the esophageal pH probe are there is no tube sticking out of the nose, and the child does not even know there is something inside. The Bravo test is generally not done under the age of four years as there is a risk that the capsule may get stuck in the bowels. Treatment for GERDTreatment of GER and GERD depends on age of the child and severity of condition. Uncomplicated GER in infants often resolves on its own, or with simple behavioral changes, and does not need medications. Some of the changes your physician may discuss include avoiding over-feeding the infant (both at individual feeds and over the entire day), burping the baby frequently, and keeping the baby upright for 30 minutes after each feed. For older children and adolescents, your doctor may advice to avoid foods that worsen GERD (for example spicy or greasy foods) and to avoid laying down right after a meal. Medications may be used for older children, or for infants with severe GERD. These include:
The medications are generally used for a defined period of time as will be discussed by your physician. The medications help healing to occur so that the child can start feeling better. Rarely, the medications are not adequate and surgery for GERD may be discussed by your physician. GERD ResearchOur Division has a strong interest in advancing our understanding of esophageal diseases, including GERD. You and your child may be offered participation in our research studies. These studies may help improve our care of children with similar problems. We would encourage you to understand the research studies, ask plenty of questions, and make an informed decision you are comfortable with. GERD ResourcesNorth American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Kids Acid Reflux Children's Digestive Health & Nutrition Foundation Parent Checklist for Infants with Reflux and GERD What is Allergic Eosinophilic Esophagitis (AEE)AEE is being increasingly recognized in infants, toddlers, children, adolescents and adults. AEE is a condition where eosinophils are found in increased levels in the esophagus (food pipe). Eosinophils are a type of white blood cell and play a role in allergies and fighting parasites. The symptoms of this condition vary and include vomiting, refusal to feed, failure to thrive, abdominal pain, heartburn and sensation that food "gets stuck" in the esophagus (dysphagia). In some cases, this may result in choking episodes. Many times these symptoms are thought to be due to gastroesophageal reflux disease (GERD) and the patient is treated with medications for GERD with minimal or no improvement. AEE is thought to an allergic reaction, most likely to something in the food that the child is eating. There is some evidence to suggest that the allergic substance may be present in the environment. Many patients with AEE also suffer from other allergic diseases such as asthma, eczema and sinus disease. How do I find if my child has Allergic Eosinophilic Esophagitis (AEE)?Diagnosis of AEE is established by examining, under a microscope, biopsies taken during an upper GI endoscopy (see "Testing for GERD"). The endoscopy may show certain findings such as vertical lines and white specks. In patients with AEE, the biopsies reveal many eosinophils in the esophageal lining. What should I expect if my child is diagnosed with Allergic Eosinophilic Esophagitis (AEE)?If results from the biopsy samples suggest AEE, your child may undergo a pH probe test (see "Testing for GERD") to ensure absence of GERD. The child will be seen by a pediatric allergist to evaluate for food allergies. On completion of the evaluation, your physician will discuss various treatment options that include use of medications (such as swallowing an anti-inflammatory medicine called corticosteroid thorough an inhaler) and a variety of dietary changes. The diet changes include avoiding the foods the child has tested allergic to, avoiding foods that commonly cause allergies (e.g., milk, soy, corn, eggs, nuts, fish and wheat), or a strict diet. Please note that dietary changes should only be done under proper supervision of your physician. Your physician will have a pediatric dietician meet with you. Your physician may schedule repeat Upper GI endoscopy to assess healing of the esophagus. It is important you maintain the appointments recommended by your physicians. AEE ResearchOur Division has a strong interest in advancing our understanding of esophageal diseases, especially GERD and AEE. You and your child may be offered participation in our research studies. These studies may help improve our care of children with similar problems. We would encourage you to understand the research studies, ask plenty of questions, and make an informed decision you are comfortable with. AEE ResourcesAllergy and Asthma Network-Mothers of Asthmatics Asthma and Allergy Foundation of America American Academy of Allergy, Asthma and Immunology American Partnership for Eosinophilic Disorders Food Allergy and Anaphylaxis Network Campaign Urging Research for Eosinophilic Disease North American Society for Pediatric Gastroenterology, Hepatology and Nutrition |
This section will discuss Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD). GER is a condition where the contents of the stomach come back up into the esophagus (food pipe). This occurs when a ring of muscle, know as the lower esophageal sphincter (LES), relaxes and creates an opening for the contents to come up. LES is located at the junction of the esophagus and the stomach. Most of us have some GER. When GER becomes excessive, resulting in complications, it is called GERD.
|
|
Copyright © 2000-2008 Web Design: NetMediaOne |
