Pathophysiology of Pediatric Gastroesophageal Reflux Disease

Abstract

Gastroesophageal reflux (GOR) is defined as "the passage of gastric contents into the esophagus with or without regurgitation and vomiting" and gastroesophageal reflux disease (GORD) is defined "when GOR leads to troublesome symptoms affecting the daily functioning and/or complications." This definition was first developed in 2006 by the Montreal consensus group (1) and later on adopted by pediatric gastroenterology societies such as ESPGHAN and NASPGHAN in 2009 (2). The definition of gastroesophageal reflux reveals little about its pathophysiology and is focused on symptomatology. In this way, it acts as an umbrella term for the multifactorial causes of the disease and the various phenotypes encountered; from functional heartburn to hypersensitive esophagus and nonerosive reflux disease, to erosive esophagitis and Barrett's esophagus. This article is devoted to the pathophysiology of pediatric GORD in comparison to adult GORD and is divided in 2 parts. In the first part, we will systematically describe the different mechanisms for the generation and clearance of reflux events, while on the second part we will discuss the mechanisms involved in symptoms generation. Finally, we will discuss the similarities and differences between pediatric and adult GORD.

Pediatric Aspects of Nutrition Interventions for Disorders of Gut-Brain Interaction

“…Infant regurgitation is one of the most frequent DGBIs in children with a prevalence of about 20% ( 2 , 8 , 32 , 33 ). Gastroesophageal reflux (GER) is a normal physiologic event that occurs multiple times a day and manifests itself as infant regurgitation ( 8 , 34 ).…”

Prevalence of Non-erosive Esophageal Phenotypes in Children: A European Multicenter Study

“…5,7,31 Several different underlying mechanisms have been suggested to explain the discrepancy in non-erosive GERD phenotype prevalence between children and adults. 32 Mahoney et al 15,28 hypothesized a predominance of peripheral and central sensitization in children. 33,34 In an adult study, patient with FH have shown a significantly higher balloon distention mechano-sensitivity and acid perfusion chemosensitivity, when compared to either patients with NERD or healthy subjects.…”

“…Esophageal hypervigilance, a form of hyperawareness and early detection of painful esophageal stimuli, is independently and significantly associated with symptoms severity and is consistent across reflux groups. 32 Nonetheless, in patients with FH, visceral neural pathways dysfunction and/or cortical processing alterations may also contribute and mediate esophageal hypersensitivity. 44 Interestingly, evoked cortical responses are produced by mucosal acid exposure in FH subjects prior to inducing heartburn.…”