Gastroesophageal reflux is a common phenomenon in infants,but the differentiation between gastro-esophageal reflux and gastroesophageal reflux disease can be difficult.Symptoms are non-specific and there is increasing...Gastroesophageal reflux is a common phenomenon in infants,but the differentiation between gastro-esophageal reflux and gastroesophageal reflux disease can be difficult.Symptoms are non-specific and there is increasing evidence that the majority of symptoms may not be acid-related.Despite this,gastric acid inhibitors such as proton pump inhibitors are widely and increasingly used,often without objective evidence or investigations to guide treatment.Several studies have shown that these medications are ineffective at treating symptoms associated with reflux in the absence of endoscopically proven oesophagitis.With a lack of evidence for efficacy,attention is now being turned to the potential risks of gastric acid suppression.Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections,bacterial overgrowth,adverse bone health,food allergy and drug interactions.展开更多
Poor growth is an under-recognised yet significant long-term sequelae of oesophageal atresia(OA)repair.Few studies have specifically explored the reasons for growth impairment in this complex cohort.The association be...Poor growth is an under-recognised yet significant long-term sequelae of oesophageal atresia(OA)repair.Few studies have specifically explored the reasons for growth impairment in this complex cohort.The association between poor growth with younger age and fundoplication appears to have the strongest supportive evidence,highlighting the need for early involvement of a dietitian and speech pathologist,and consideration of optimal medical reflux management prior to referring for anti-reflux surgery.However,it remains difficult to reach conclusions regarding other factors which may negatively influence growth,due to conflicting findings,inconsistent definitions and lack of validated tool utilisation.While swallowing and feeding difficulties are particularly frequent in younger children,their relationship with growth remains unclear.It is possible that these morbidities impact on the diet of children with OA,but detailed analysis of dietary composition and quality,and its relationship with these complications and growth,has not yet been conducted.Another potential area of research in OA is the role of the microbiota in growth and nutrition.While the microbiota has been linked to growth impairment in other paediatric conditions,it is yet to be investigated in OA.Further research is needed to identify the most important contributory factors to poor growth,the role of the intestinal microbiota,and effective interventions to maximise growth and nutritional outcomes in this cohort.展开更多
文摘Gastroesophageal reflux is a common phenomenon in infants,but the differentiation between gastro-esophageal reflux and gastroesophageal reflux disease can be difficult.Symptoms are non-specific and there is increasing evidence that the majority of symptoms may not be acid-related.Despite this,gastric acid inhibitors such as proton pump inhibitors are widely and increasingly used,often without objective evidence or investigations to guide treatment.Several studies have shown that these medications are ineffective at treating symptoms associated with reflux in the absence of endoscopically proven oesophagitis.With a lack of evidence for efficacy,attention is now being turned to the potential risks of gastric acid suppression.Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections,bacterial overgrowth,adverse bone health,food allergy and drug interactions.
文摘Poor growth is an under-recognised yet significant long-term sequelae of oesophageal atresia(OA)repair.Few studies have specifically explored the reasons for growth impairment in this complex cohort.The association between poor growth with younger age and fundoplication appears to have the strongest supportive evidence,highlighting the need for early involvement of a dietitian and speech pathologist,and consideration of optimal medical reflux management prior to referring for anti-reflux surgery.However,it remains difficult to reach conclusions regarding other factors which may negatively influence growth,due to conflicting findings,inconsistent definitions and lack of validated tool utilisation.While swallowing and feeding difficulties are particularly frequent in younger children,their relationship with growth remains unclear.It is possible that these morbidities impact on the diet of children with OA,but detailed analysis of dietary composition and quality,and its relationship with these complications and growth,has not yet been conducted.Another potential area of research in OA is the role of the microbiota in growth and nutrition.While the microbiota has been linked to growth impairment in other paediatric conditions,it is yet to be investigated in OA.Further research is needed to identify the most important contributory factors to poor growth,the role of the intestinal microbiota,and effective interventions to maximise growth and nutritional outcomes in this cohort.
