Evaluation and Management of the Pediatric Patients with Suspected Gastroesophageal Reflux Diseases

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Badriul Hegar*, Yvan Vandenplas**

*Department  of  Child  Health,  Faculty  of  Medicine,  University  of  Indonesia Dr.  Cipto  Mangunkusumo  General  National  Hospital,  Jakarta,  Indonesia

**  UZ  Brussel  Kinderen,  Vrije  Universiteit  Brussel,  Belgia

ABSTRACT

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children²

Gastrointestinal  obstruction Pyloric  stenosis

Malrotation  with  intermittent   volvulus

Intestinal  duplication Hirschsprung  disease Antral/duodenal  web Foreign  body Incarcerated  hernia Other  gastrointestinal  

disorders

Achalasia Gastroparesis Gastroenteritis Peptic  ulcer

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gastroenteritis Food  allergy

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Meningitis

Urinary  tract  infection Pneumonia

Otitis  media Hepatitis Metabolic/endocrine Galactosemia

Hereditary  fructose  intolerance Urea  cycle  defects

Amino  and  organic  acidemias Congenital  adrenal  hyperplasia

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Table  2.  History  of  children  with  suspected  gastroesophageal   UHÀX[GLVHDVH²

Feeding  and   dietary  history

Amount/frequency  (overfeeding) Preparation  of  formula

Recent  changes  in  feeding  type  or    technique Position  during  feeding

Burping

Behavior  during  feeding:  choking,  gagging,   cough,  arching,  discomfort,  refusal Pattern  of  

vomiting

Frequency/amount Pain

Forceful Blood  or  bile

Associated  fever,  lethargy,  diarrhea Past  medical  

history

Prematurity

Growth  and  development   Past  surgery,  hospitalizations Newborn  screen  results

Recurrent  illnesses,  especially  croup,   pneumonia,  asthma

Symptoms  of  hoarseness,  fussiness,  hiccups,   apnea

Previous  weight  and  height  gain Other  chronic  conditions

Medications Current,  recent,  prescription,  non-­prescription Family  psycho-­

social  history

Sources  of  stress

Maternal  or  paternal  drug  use Post  partum  depression Family  medical  

history

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Family  history  of  gastrointestinal  disorders Family  history  of  atopy

Growth  chart   including  height,   weight  and  head   circumference

Warning  signals  (see  Table  3)

Table  3.  Warning  signals  requiring  investigation  in  infants  with   regurgitation  or    vomiting²  

Bilious  vomiting Lethargy

Gastrointestinal   bleeding:   hematemesis,   hematochezia

Hepatosplenomegaly

Consistently  forceful  vomiting     Bulging  fontanelle Onset  of  vomiting  after  6  months  of  life   Macro/microcephaly

Failure  to  thrive Seizures

Abdominal  tenderness  or  distension     Diarrhea

Constipation Fever

Documented  or  suspected  genetic/metabolic   syndrome

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