סיבוכים של רפלוקס קיבתי- וישטי

Gastro esophageal reflux is generally defined as the spontaneous passage of gastric contents into the esophagus. It is believed that the reflux occurs during episodes of transient relaxation of the lower esophageal sphincter or inadequate adaptation of the sphincter tone to changes in abdominal pressure.
It affects children in either an infantile form or as an affliction of older children.
Up to 50 % of normal infants may have regurgitation that spontaneously resolves by 2 years of age. As such, gastro esophageal reflux is a normal physiologic process in healthy infants, but is considered pathologic in older children
Prolonged local contact of gastric content with esophageal mucosa may cause esophagitis, stricture and malignancy.
Extra esophageal manifestations of gastric acid reflux are wide and include: chronic cough, aggravation of asthma symptoms, recurrent pneumonia, hoarseness, laryngitis, chronic rhinitis, sinusitis, globus pharyngeus, recurrent croup, laryngomalacia, subglottic stenosis, otitis, vocal cord granulomas and enamel teeth disorders.
These complications may be the direct result of acid reflux contact or by a reflex arc threw vagal nerve pathway.
The cause and effect relationship between reflux disease and the majority of these disorders has not been clearly established, as most studies are uncontrolled and consist of small samples of children from referral centers. Furthermore, these manifestations often occur in the absence of classical symptoms of GERD, such as vomiting, heartburn or chest pain. This phenomenon is often referred to as “silent GERD”. Although the awareness of silent GERD is increasing, the documentation that acid reflux is responsible is sparse.
Usually clinical symptoms and physical examination are sufficient for diagnosis and treatment. In some difficult situations it necessary to perform medical tests such as: Ph probe, scintigraphy, barium contrast radiography, endoscopy & biopsy.
The goals of treatment are to provide complete relief of symptoms and to treat and prevent complications, which significantly improve quality of life. Changes of life style and control of acid secretion are the most effective means to achieve these treatment goals. In difficult cases surgical procedures are required