Gastroesophageal Reflux  (GER)  in Infants

The lower esophageal sphincter (LES) normally opens to release gas after meals.

With infants, when the LES opens, stomach contents often reflux into the esophagus and out the mouth, resulting in:

  • regurgitation, or
  • spitting up, and
  • Vomiting

GER can also occur when babies cough, cry, or strain.

Gastroesophageal Reflux  Disease (GERD) in Infants

More than ½ of all babies experience reflux in the first 3 months of life, but  most  stop spitting up between the ages of 12 to 24 months.

Only a small number of infants have severe symptoms as:

  • Regurgitation or vomiting with poor  weight gain
  • Persistent Irritability pain in infants
  • Lower chest pain, dysphagia, pyrosis
  • Heamatemisis with Iron deficiency anemia
  • Coughing , wheezing, stridor
  • Aspiration, Recurrent pneumonia,   
  • Apnea, Cyanosis
  • Neck tilting ( Sandifer’s Syndrome)


Treatments of Hyperacidity

 

Antacid

H2  Antagonist   ( Ranitidine )

Proton Pump Inhibitors

Mechanism of  Action

- Contains Magnesium Hydroxide, Aluminium Hydroxide gel and dimethicone which act by Neutralizing Hydrochloric acid in the gastric mucosa thus protecting it from acid and pepsin and reliving pain in the symptomatic management of peptic ulcers reflux , oesophagitis and heart burn.

They reduce the basal  food stimulated and nocturnal secretion of gastric acid by blocking the histamine receptors H2 in the stomach.

- They diffuse from the blood to the apical membrane of parietal cells where H+, K+ ATPase (proton pump) exists - Irreversibly inhibit the PP activity and consequently inhibit acid production.

- This inhibition is noncompetitive as it blocks the final step in gastric acid secretion irrespective of the stimulus.

Major side effects

•      Constipation

•      Mood changes

•      In patients with renal impairment long term administration of AL3+ can exacerbate or initiate osteoporosis

•      Constipation, diarrhoea, nausea/vomiting, abdominal pain.

•      Rarely, malaise, dizziness, insomnia and vertigo.

•      Tachyphylaxis

Aclorhydria- Atrophic gastritis- pernicious aneamia ( def. of vit B12)

Hip fracture

Nausea , Abdominal pain , Constipation , Flatulance , Diarrhea , skin rashes , Arthralgia.