Department of Pediatrics, University of Bari Policlinico Piazza G,Cesare, 70124 Bari, Italy.
Ital J Pediatr. 2009 Dec 9;35(1):39. doi: 10.1186/1824-7288-35-39.
Uncomplicate regurgitation in otherwise healthy infants is not a disease. It consists of milk flow from mouth during or after feeding. Common causes include overfeeding, air swallowed during feeding, crying or coughing; physical exam is normal and weight gain is adequate. History and physical exam are diagnostic, and conservative therapy is recommended. Pathologic gastroesophageal reflux or gastroesophageal reflux disease refers to infants with regurgitation and vomiting associated with poor weight gain, respiratory symptoms, esophagitis. Reflux episodes occur most often during transient relaxations of the lower esophageal sphincter unaccompanied by swallowing, which permit gastric content to flow into the esophagus. A minor proportion of reflux episodes occurs when the lower esophageal sphincter fails to increase pressure during a sudden increase in intraabdominal pressure or when lower esophageal sphincter resting pressure is chronically reduced. Alterations in several protective mechanisms allow physiologic reflux to become gastroesophageal reflux disease; diagnostic approach is both clinical and instrumental: radiological series are useful to exclude anatomic abnormalities; pH-testing evaluates the quantity, frequency and duration of the acid reflux episodes; endoscopy and biopsy are performed in the case of esophagitis. Therapy with H2 receptor antagonists and proton pump inhibitors are suggested.
非病态的、健康婴儿的单纯性反流不是一种疾病，它是指婴儿在进食中或进食后，奶液从口腔反流出来。常见的病因包括喂食过量、在进食过程中吞咽了空气、哭泣或咳嗽等。体格检查通常正常，体重增长也正常。病史和体格检查即可诊断，推荐进行保守治疗。病理性胃食管反流或胃食管反流病是指反流和呕吐与体重增长不良、呼吸症状、食管炎相关的婴儿。反流发作最常发生在下食管括约肌在不伴有吞咽的短暂松弛期间，这允许胃内容物流入食管。当下食管括约肌在腹内压突然增加时未能增加压力，或者当下食管括约肌静息压力持续降低时，会发生一小部分反流发作。几种保护机制的改变可使生理性反流变为胃食管反流病；诊断方法既有临床方法，也有仪器方法：放射学系列检查有助于排除解剖异常；pH 测试评估酸反流发作的数量、频率和持续时间；在食管炎的情况下进行内镜检查和活检。建议使用 H2 受体拮抗剂和质子泵抑制剂进行治疗。
