TRÀO NGƯỢC DẠ DÀY THỰC QUẢN Ở TRẺ EM ,ĐH Y DƯỢC TP HCM

bài giảng dành cho sinh viên y khoa, bác sĩ, sau đại học , ĐH Y DƯỢC TP HCM CLINICAL FEATURES apnea, chronic lung disease, poor weight gain behavioral TREATMENT Nonpharmacologic Treatments Positioning: semisupine positioning (sitting) in an infant seat was found to exacerbate GER, whereas the prone position was superior. van Wijk and colleagues54 found faster gastric emptying and less liquid reflux with a strategy of feeding infants in the right decubitus position followed by position change to the left decubitus position 1 hour later

Gastro-Esophageal Reflux

Phùng Nguyễn Thế Nguyên MD

- incidence of GER: 22% to 85% of premature infants

- acid-suppression therapy for GERD: nearly 25% of very

low birth weight infants

mechanisms in preterm infants

- transient relaxation of the lower esophageal sphincter

CLINICAL FEATURES

- apnea,

- chronic lung disease,

- poor weight gain

- behavioral

Apnea

- occurs during or following feeding periods

- It is postulated that refluxate during the GER episodes

stimulates laryngeal chemoreflexes

- obstructive, central, and mixed apneas as well as other

reflex activities including cough, increased swallowing, and arousal

- Aggressive treatment of GER with medication (prokinetic

agents, antacids) or surgery resolved the apneas

Bronchopulmonary Dysplasia

- affects 30% of preterm infants with a birth weight under 1

kg

Growth

- Failure to thrive is a sign often attributed to GER in infants

Behavior

- irritability, facial grimacing, head arching, and frequent

swallowing have been attributed to GER, particularly in older infants

TREATMENT

- Nonpharmacologic Treatments

- Positioning:

 semisupine positioning (sitting) in an infant seat was

found to exacerbate GER, whereas the prone position was superior

 van Wijk and colleagues54 found faster gastric

emptying and less liquid reflux with a strategy of feeding infants in the right decubitus position followed

by position change to the left decubitus position 1 hour later

- Manipulation of feeds

- Thickening of feeds: cereals or the use of newer

milk-based formulas that thicken upon acidification in the stomach reduces the number and height of nonacid reflux episodes and regurgitation but does not decrease acid reflux events

- Pharmacologic Treatments:

 Pharmacotherapy focuses on reducing the exposure to

esophageal acid, either by buffering or reducing secreted gastric acid

 None of the available currently available agents

prevents regurgitation

- Acid neutralizers and surface agents: Because of the risk

of heavy-metal toxicity, chronic antacid use in preterm infants is not recommended

- Prokinetic therapies: limited role in the treatment of GERD

in preterm infants because of their lack of efficacy demonstrated in large meta-analyses (metoclopramide) and potential cardiac (domperidome and cisapride) or neurologic (metoclopramide and domperidome) side effects

 Bethanachol, Erythromycin, Baclofen

- Acid-Suppression Therapies

 H2-receptor antagonists: ranitidine, Famotidine,

 Proton-pump inhibitors: lansoprazole and omeprazole

- Risks of acid suppression

 increased risk of necrotizing enterocolitis

 late-onset sepsis

- Antireflux Surgery

- Current medical therapy almost always provides adequate

treatment for esophageal complications of GER

- Phẫu thuật thường được chỉ định trong ca không đáp ứng

hoặc đáp ứng kém với điều trị nội khoa

- Đó là các phương pháp tạo nếp gấp đáy vị (phẫu thuật

Nissen, phẫu thuật Toupet), hoặc các phương pháp can thiệp qua nội soi (khâu CVDTQ qua nội soi, Tiêm chất sinh học làm tăng khối cơ)

Nissen fundoplication

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