Gastroesophageal Reflux Disorder: Difficulties in Diagnosis and Treatment in Infants

Abstract

Gastroesophageal Reflux Disease (GERD), as the name suggests, is a condition wherein there is a reflux of the contents of the stomach towards the oesophagus, which eventually leads to pathological changes in the oesophagus itself if not managed at an early stage appropriately. Here we present a case of a 6 month old infant who presented with a history of repeated cough, fever, difficulty in breathing and poor weight gain. Various physicians saw the infant, however, due to worsening symptoms and no relief, the infant presented to the paediatric emergency department of the Abbasi Shaheed Hospital. An initial management for pneumonia was done but there was a persistence of symptoms even after clearance of the pneumonic patch. An upper gastrointestinal (GI) imaging study, including Barium swallow and fluoroscopy was done to evaluate the anatomy of the upper gastrointestinal tract which showed mild to moderate reflux but no strictures, stenosis, achalasia or gastric outlet obstruction. The infant was managed via medical intervention and lifestyle counselling. On follow-up, the infant improved clinically and gained weight. It is extremely important in such cases to have a strong clinical suspicion of Gastroesophageal reflux (GER) which may lead to GERD, while assessing the patient's signs and symptoms and to support the diagnosis of GERD with appropriate investigations and management.