bài giảng dành cho sinh viên y khoa, bác sĩ, sau đại học , ĐH Y DƯỢC TP HCM CLINICAL FEATURES apnea, chronic lung disease, poor weight gain behavioral TREATMENT Nonpharmacologic Treatments Positioning: semisupine positioning (sitting) in an infant seat was found to exacerbate GER, whereas the prone position was superior. van Wijk and colleagues54 found faster gastric emptying and less liquid reflux with a strategy of feeding infants in the right decubitus position followed by position change to the left decubitus position 1 hour later
Gastro-Esophageal Reflux Phùng Nguyễn Thế Nguyên MD - incidence of GER: 22% to 85% of premature infants - acid-suppression therapy for GERD: nearly 25% of very low birth weight infants mechanisms in preterm infants - transient relaxation of the lower esophageal sphincter CLINICAL FEATURES - apnea, - chronic lung disease, - poor weight gain - behavioral Apnea - occurs during or following feeding periods - It is postulated that refluxate during the GER episodes stimulates laryngeal chemoreflexes - obstructive, central, and mixed apneas as well as other reflex activities including cough, increased swallowing, and arousal - Aggressive treatment of GER with medication (prokinetic agents, antacids) or surgery resolved the apneas Bronchopulmonary Dysplasia - affects 30% of preterm infants with a birth weight under kg Growth - Failure to thrive is a sign often attributed to GER in infants Behavior - irritability, facial grimacing, head arching, and frequent swallowing have been attributed to GER, particularly in older infants TREATMENT - Nonpharmacologic Treatments - Positioning: semisupine positioning (sitting) in an infant seat was found to exacerbate GER, whereas the prone position was superior van Wijk and colleagues54 found faster gastric emptying and less liquid reflux with a strategy of feeding infants in the right decubitus position followed by position change to the left decubitus position hour later - Manipulation of feeds - Thickening of feeds: cereals or the use of newer milkbased formulas that thicken upon acidification in the stomach reduces the number and height of nonacid reflux episodes and regurgitation but does not decrease acid reflux events - Pharmacologic Treatments: Pharmacotherapy focuses on reducing the exposure to esophageal acid, either by buffering or reducing secreted gastric acid None of the available prevents regurgitation currently available agents - Acid neutralizers and surface agents: Because of the risk of heavy-metal toxicity, chronic antacid use in preterm infants is not recommended - Prokinetic therapies: limited role in the treatment of GERD in preterm infants because of their lack of efficacy demonstrated in large meta-analyses (metoclopramide) and potential cardiac (domperidome and cisapride) or neurologic (metoclopramide and domperidome) side effects Bethanachol, Erythromycin, Baclofen - Acid-Suppression Therapies H2-receptor antagonists: ranitidine, Famotidine, Proton-pump inhibitors: lansoprazole and omeprazole - Risks of acid suppression increased risk of necrotizing enterocolitis late-onset sepsis - Antireflux Surgery - Current medical therapy almost always provides adequate treatment for esophageal complications of GER - Phẫu thuật thường định ca không đáp ứng đáp ứng với điều trị nội khoa - Đó phương pháp tạo nếp gấp đáy vị (phẫu thuật Nissen, phẫu thuật Toupet), phương pháp can thiệp qua nội soi (khâu CVDTQ qua nội soi, Tiêm chất sinh học làm tăng khối cơ) Nissen fundoplication Trân trọng cảm ơn ...- incidence of GER: 22% to 85% of premature infants - acid-suppression therapy for GERD: nearly 25% of very low birth weight infants mechanisms in preterm... swallowing, and arousal - Aggressive treatment of GER with medication (prokinetic agents, antacids) or surgery resolved the apneas Bronchopulmonary Dysplasia - affects 30% of preterm infants with... enterocolitis late-onset sepsis - Antireflux Surgery - Current medical therapy almost always provides adequate treatment for esophageal complications of GER - Phẫu thuật thường định ca không đáp ứng