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Causes and pathogenesis of gastroesophageal reflux disease in children
Medical expert of the article
Last reviewed: 06.07.2025
Gastroesophageal reflux disease is a consequence of pathological gastroesophageal 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 per day), and is practically independent of food intake. Damage to the esophageal mucosa caused by gastroesophageal reflux leads to the formation of esophageal and extraesophageal symptoms.
The main factors that form gastroesophageal reflux:
- lower esophageal sphincter insufficiency:
- violation of esophageal clearance;
- violation of gastroduodenal motility.
The listed factors may be caused by regulatory disorders or inflammatory changes in the stomach and duodenum. Sliding hernia of the esophageal orifice 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 intestinal metaplasia (Barrett's esophagus) in children with long-term gastroesophageal reflux. The risk group includes children who have suffered chronic intrauterine hypoxia, birth asphyxia, postnatal hypoxia, severe infections and CNS lesions.
Additional factors that provoke the development of gastroesophageal reflux disease:
- violation of the diet and quality of nutrition;
- conditions accompanied by increased intra-abdominal pressure (constipation, inadequate physical activity, prolonged inclined position of the body, obesity, etc.);
- respiratory pathology (bronchial asthma, cystic fibrosis, recurrent bronchitis, etc.);
- medications (anticholinergics, sedatives and hypnotics, beta-blockers, 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 both as a result of functional insufficiency of the valves and/or sphincters of the hollow organs, and in connection with a change in the pressure gradient in them.
Gastroesophageal reflux refers to the involuntary flow or reflux of stomach or gastrointestinal contents into the esophagus. It is generally a normal phenomenon observed in humans and does not cause pathological changes in surrounding organs.
Physiological gastroesophageal reflux is usually observed after meals, characterized by the absence of clinical symptoms, short duration of gastroesophageal reflux episodes, rare episodes of reflux during sleep. In addition to physiological gastroesophageal reflux, with prolonged exposure of acidic gastric contents in the esophagus, pathological gastroesophageal reflux may occur, which is observed in gastroesophageal reflux disease. In this case, the physiological movement of chyme is disrupted, which is accompanied by the entry of contents into the esophagus and then into the oropharynx, capable of causing damage to the mucous membranes.
Pathological gastroesophageal reflux is characterized by frequent and prolonged episodes of reflux, observed day and night, causing symptoms indicating damage to the mucous membrane of the esophagus and other organs. In addition, microbial flora that is not typical for it gets into the esophagus, which can also cause inflammation of the mucous membranes.
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