Table of Contents
ISRN Gastroenterology
Volume 2013 (2013), Article ID 824320, 8 pages
http://dx.doi.org/10.1155/2013/824320
Review Article

Gastroesophageal Reflux in Critically Ill Children: A Review

1Pediatric Intensive Care Department and Gastroenterology Section, Gregorio Marañón University General Hospital, 28009 Madrid, Spain
2Servicio de Cuidados Intensivos Pediátricos, Instituto de Investigación del Hospital Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Dr. Castelo 47, 28009 Madrid, Spain

Received 21 December 2012; Accepted 10 January 2013

Academic Editors: J.-P. Buts, U. Klinge, I. Takeyoshi, and W. Vogel

Copyright © 2013 Maria José Solana García et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gastroesophageal reflux (GER) is very common in children due to immaturity of the antireflux barrier. In critically ill patients there is also a high incidence due to a partial or complete loss of pressure of the lower esophageal sphincter though other factors, such as the use of nasogastric tubes, treatment with adrenergic agonists, bronchodilators, or opiates and mechanical ventilation, can further increase the risk of GER. Vomiting and regurgitation are the most common manifestations in infants and are considered pathological when they have repercussions on the nutritional status. In critically ill children, damage to the esophageal mucosa predisposes to digestive tract hemorrhage and nosocomial pneumonia secondary to repeated microaspiration. GER is mainly alkaline in children, as is also the case in critically ill pediatric patients. pH-metry combined with multichannel intraluminal impedance is therefore the technique of choice for diagnosis. The proton pump inhibitors are the drugs of choice for the treatment of GER because they have a greater effect, longer duration of action, and a good safety profile.