Causes and pathogenesis of gastroesophageal reflux disease in children

Gastoesophageal reflux disease is a consequence of pathological gastro-ephofagic reflux: acidic (pH <4.0), alkaline (pH> 7.5), or mixed.

Pathological gastroesophageal reflux occurs at any time of the day, very often (> 50 episodes a day), practically independent of food intake. The esophageal mucosa damage caused by gastroesophageal reflux leads to the formation of esophageal and extra-oesophageal symptoms.

The main factors forming gastroesophageal reflux:

• insufficiency of the lower esophageal sphincter:
• violation of esophageal clearance;
• violation of gastroduodenal motor skills.

These factors may be due to regulatory disorders or inflammatory changes in the stomach and duodenum. Slipping hernia of the esophageal opening of the diaphragm aggravates the course of gastroesophageal reflux disease. The combination of such a hernia with duodenogastric reflux is a risk factor for the formation of metaplasia of the intestinal type (Barrett's esophagus) in children with long-standing gastroesophageal reflux. The risk group is children who have suffered chronic intrauterine hypoxia, asphyxia in childbirth, who have postnatal hypoxia, severe infections and CNS lesions.

Additional factors provoking the development of gastroesophageal reflux disease:

• violation of the regime and quality of nutrition;
• conditions accompanied by increased intra-abdominal pressure (constipation, inadequate physical activity, prolonged oblique position of the trunk, obesity, etc.);
• respiratory pathology (bronchial asthma, cystic fibrosis, recurrent bronchitis, etc.);
• drugs (cholinolytics, sedatives and hypnotics, p-adrenoblockers, nitrates, etc.);
• smoking, drinking alcohol.

From the point of view of general pathology, reflux, as such, is the movement of liquid contents in any communicating hollow organs in the opposite, antiphysiological direction. This can occur as a result of functional failure of valves and / or sphincters of hollow organs, and in connection with the change in the pressure gradient in them.

Gastroesophageal reflux means the involuntary flowing or throwing of gastric or gastrointestinal contents into the esophagus. Basically, this is a normal phenomenon observed in a person, in which pathological changes in surrounding organs do not develop.

Physiological gastroesophageal reflux is usually noted after eating, characterized by a lack of clinical symptoms, a minor duration of episodes of gastroesophageal reflux, and rare episodes of reflux during sleep. In addition to physiological gastroesophageal reflux, with prolonged exposure of acidic gastric contents in the esophagus, abnormal gastroesophageal reflux may occur , which is observed in gastro-ephoflagic reflux disease. At the same time, the physiological movement of the chyme is disturbed, which is accompanied by the entry into the esophagus and further into the oropharynx, of the contents capable of causing damage to the mucous membranes.

Long pathological gastroesophageal reflux is characterized by frequent and prolonged episodes of reflux observed day and night and causing the appearance of symptoms that indicate the damage to the mucosa of the esophagus and other organs. In addition, the microbial flora that is uncharacteristic of it enters the esophagus, which can also cause inflammation of the mucous membranes.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]