Catto-Smith A G
Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Parkville, Victoria.
Aust Fam Physician. 1998 Jun;27(6):465-9, 472-3.
Gastroesophageal reflux is common in small children. It is important to recognise that its natural history and management differ from reflux in adults.
This article will summarise the clinical presentation, pathophysiology, appropriate investigations and therapy of reflux in small children.
A small amount of regurgitation is common in infancy, and is only pathological if it results in harm. In children, reflux-induced injury can result from either acid exposure, nutrient loss or respiratory complications. Recognised presentations include heartburn, oesophagitis, infant irritability, dysphagia, haematemesis, stricture, growth failure, aspiration, apnoea and pneumonia. Excessive crying and irritable behaviour in infancy can be due to a variety of causes, but there is a fashionable tendency to assume that gastroesophageal reflux is a major factor. Regurgitation can be a symptom of other conditions such as infection or metabolic disturbance. It is important to carefully evaluate any infant with distressed behaviour to exclude a significant medical cause. Prolonged oesophageal pH monitoring is a very useful means of linking episodes of reflux with putative symptoms. The severity of gastroesophageal reflux tends to improve with age in infants and this should be considered when advising appropriate therapy, especially fundoplication.
胃食管反流在幼儿中很常见。认识到其自然病程和治疗方法与成人反流不同很重要。
本文将总结幼儿反流的临床表现、病理生理学、适当的检查和治疗。
婴儿期少量反流很常见，只有当它导致伤害时才是病理性的。在儿童中，反流引起的损伤可能由酸暴露、营养物质流失或呼吸道并发症导致。公认的表现包括烧心、食管炎、婴儿易激惹、吞咽困难、呕血、狭窄、生长发育迟缓、误吸、呼吸暂停和肺炎。婴儿期过度哭闹和易激惹行为可能由多种原因引起，但有一种流行的趋势认为胃食管反流是一个主要因素。反流可能是其他疾病如感染或代谢紊乱的症状。仔细评估任何有痛苦行为的婴儿以排除重大医学原因很重要。长时间食管pH监测是将反流发作与假定症状联系起来的非常有用的方法。婴儿胃食管反流的严重程度往往随着年龄增长而改善，在建议适当治疗尤其是胃底折叠术时应考虑这一点。
