What is reflux?
Reflux occurs when contents taken into the stomach are regurgitated back up through the gastrointestinal system. The contents can come all the way up and out (vomiting) or may come partway up and then back down (silent reflux). The condition is referred to as GERD (GastroEsophageal Reflux Disease). GERD damages the esophagus. It also contributes to asthma and pulmonary fibrosis.
Virtually all children with HIE have reflux. When our kids reflux, even if it is silent, they run a much higher risk of aspiration pneumonia than a typically developing child would. Aspiration pneumonia occurs when the stomach contents go back down the wrong way, into the lungs. Since HIE kids have weak or nonexistent suck, swallow, and gag reflexes, reflux is very dangerous to them.
What can be done about reflux?
There are four areas which gastroenterologists can focus on for treatment and prevention of GERD. The four areas are use of a gastrojejunal tube, medications, surgery, and positioning.
Percutaneous Endoscopic Gastrostomy
The use of a gastrojejunal (GJ) tube helps some. A GJ tube is placed using a PEJ (Percutaneous Endoscopic Jejunostomy) procedure. This type of tube protrudes farther into the GI tract than a regular Gtube or Gbutton, past the stomach. This should lessen the incidence of reflux.
However, some studies have shown that it does not lessen aspiration. Other studies show that in the long term there is a significant decrease in lung disease using a GJ tube than with a Gtube or button.
Aspiration pneumonia is a known complication of a nasal or oral gastric tube, partially because the tube may slip part of the way out, pumping formula into the esophagus or throat accidentally. Therefore, research seems to show that PEJ reduces the risk of aspiration pneumonia better than the other tubes in the absence of fundoplication.
With PEJ there is a greater incidence of tube dysfunction than with Gtube. One study showed an 84% failure rate for the PEJ. Here is a website for care of a GJ tube: http://www.cincinnatichildrens.org/famil... .
Medications
Various medications are used for children and infants with reflux. These medications do one of two things. Some medications, called H2 blockers, are antihistamines that block the release of stomach acid to reduce heartburn. Those include cimetidine (Tagamet) and ranitidine (Zantac). Cisapride (Propulsid) and metaclopramide (Reglan) are two drugs that improve esophageal motility, thereby decreasing the amount of time the acid is in contact with the esophagus.
