1 / 16

REFLUJO GASTROESOFAGICO EN PEDIATRIA

REFLUJO GASTROESOFAGICO EN PEDIATRIA. DR ALFREDO MORA GUEVARA JEFE SERVICIO GASTROENTEROLIGA NUTRICION CLINICA HOSPITAL NACIONAL DE NINOS 2012. CASO CLINICO.

laurie
Download Presentation

REFLUJO GASTROESOFAGICO EN PEDIATRIA

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. REFLUJO GASTROESOFAGICO EN PEDIATRIA DR ALFREDO MORA GUEVARA JEFE SERVICIO GASTROENTEROLIGA NUTRICION CLINICA HOSPITAL NACIONAL DE NINOS 2012

  2. CASO CLINICO • PACIENTE MASCULINO 5 SEMANAS DE EDAD, PESO 5 KG , SE ALIMENTA CON LECHE MATERNA CADA 30-60 MINUTOS, O CUANDO EL LACTANTE LO PIDE. VOMITA LUEGO DE CADA TOMA, A VECES EN CANTIDADES IMPORTANTES. MADRE SE LOGRA EXTRAER HASTA 4 ONZAS EN 5/10 MINUTOS CON LA MAQUINA EXTRACTORA DE LECHE. LA MADRE PONE AL NINO AL PECHO 15-20 MINUTOS. LOS VOMITOS NO SON BILIOSOS

  3. CASO CLINICO • ESCOJA LA CORRECTA. LA CAUSA DE VOMITOS EN ESTE LACTANTE ES: • A-SOBREAALIMENTACION • B-GASTROENTERITIS • C-ALERGIA A LA LACTOSA • D-POBRE SUCCION • E-NINGUNA DE LAS ANTERIORES

  4. CASO CLINICO • PACIENTE FEMENINA 4 MESES DE EDAD, CON HISTORIA DE VOMITOS POSTPRANDIALES, NO BILIOSOS, NIEGA HEMETEMESIS. DEPOSICIONES NORMALES. PESO: 6.5 KG, TALLA: 64 CM. LA MADRE LE DA LACTANCIA MATERNA 2-3 VECES POR DIA, Y FORMULA A BASE DE PROTEINA DE VACA 4 ONZAS CADA 3 HORAS (TOTAL 6 CHUPONES POR DIA).

  5. CASO CLINICO • RECOMENDACIONES A LA MADRE, PARA DISMINUIR EL VOMITO (ESCOJA LA CORRECTA: • A-DISMINUIR EL VOLUMEN DE LAS TOMAS Y CORREGIR VOLUMEN DEL BIBERON (MENOS)CUANDO LE DA LECHE MATERNA. • B-CAMBIAR EL TIPO DE BIBERON • C-INTRODUCIR AGUA 3 ONZAS , 4 TOMAS AL DIA, ADEMAS DE LA LECHE MATERNA Y FORMULA • NINGUNA DE LAS ANTERIORES.

  6. Miura MS, Mascaro M, Rosenfeld RM. • OtolaryngolHead Neck Surg. 2012 Mar;146(3):345-52. Epub 2011 Dec 9. Brazil Portoalegre Univ. • Association between otitis media and gastroesophagealreflux:a systematic review • Of 242 initial studies, 15 met inclusion criteria. The authors found a mean prevalence of gastroesophagealreflux disease in children with chronic otitis media with effusion of 48.4% (range, 17.6%-64%) and in children with recurrent acute otitis media of 62.9% (range, 61.5%-64.3% • Antireflux therapy for otitis media cannot be endorsed based on existing research

  7. REFLUJO GASTROESOFAGICO EN LACTANTES (RGE) • RGE es el paso de contenidogastricohacia el esofago. • 50-60% de todos los lactantes de 0-3 mesesregurgitan al menos 1 vez al dia. • Luego 5% de los lactantespresentan RGE de los 10-12 meses de edad. • 3% de los Padres de 10-12 meses de edadven el RGE como un problemaclinico. • Craig WR, Hanlon-Dearman A, Sinclair C, Taback SP, Moffatt M. • Pediatric Emergency, University of Alberta

  8. REFLUJO GASTROESOFAGICO EN LACTANTES (RGE) • Craig WR, Hanlon-Dearman A, Sinclair C, Taback SP, MoffattMWITHDRAWN: Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years Cochrane Database Syst Rev. 2010 May 12;(5):CD003502. Pediatric Emergency, University of Alberta

  9. REFLUJO GASTROESOFAGICO EN LACTANTES (RGE) • Trials were identified by searching Cochrane Central Register of Controlled Trials (The Cochrane Library 2003), MEDLINE (January 1966 to 23 January 2003), EMBASE (January 1985 to 27 January 2003), and reference lists of articles. Searches in all databases were updated in April 2009. • Randomised studies (parallel or cross over) which evaluated thickened feeds, positional alternations or metoclopramide for the treatment of GER in children between the age of one month and two years who were developmentally normal

  10. REFLUJO GASTROESOFAGICO EN LACTANTES (RGE • 20 estudios (771 ninostuvieron los criteriosclinicos. 8 espesamiento de la formula, 5 con posicion anti-reflujo y 7 con metoclopramida. • Espesamiento de la formula reduce los sintomas de RGE • Elevacion de la cabecera de la cama no tuvoefecto en la reduccion de RGE • Metoclopramidareportoalgunosbeneficios en comparacion con el placebo en ninos con RGE sintomaticos, per debesopesarseriesgo-beneficio.

  11. Ranjitkar S, Smales RJ, Kaidonis JA • J GastroenterolHepatol. 2012 Jan;27(1):21-7. doi: 10.1111/j.1440-1746.2011 Adelaide, South Australia, Australia • Oral manifestations of gastroesophageal reflux disease •  PPIs do not always result in adequate acid suppression •  Adequate salivary secretions are essential for the protection of the teeth and the oropharyngeal and esophageal mucosa. • Proton pump inhibitors (PPIs), can cause hyposalivation. 

  12. COUGH AND GER • ChangAB, LassersonT, GaffneyJ. et al • Gastro-oesophagealreflux treatment for prolonged non-specific cough in children and adults • All randomised controlled trials (RCTs) on GORD treatment for cough in children and adults without primary lung disease • Included 19 studies (six paediatric, 13 adults). None of the paediatric studies could be combined for meta-analysis. A single RCT in infants found that PPI (compared to placebo) was not efficacious for cough outcome

  13. COUGH AND GER • PPI is not efficacious for cough associated with GORD symptoms in very young children (including infants) and should not be used for cough outcomes. • There is insufficient data in older children to draw any valid conclusion

  14. EFFICACY OF PPI’S AND GER • van derPol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA. • Department of Pediatric Gastroenterology and Nutrition, Amsterdam, Netherland • Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review • Pediatrics. 2011 May;127(5):925-35. Epub 2011 Apr 4

  15. EFFICACY OF PPI’S AND GER • 12 Estudios de 0-17 anos • Lactantes: . PPIs masefectivo en 1 estudioque ;a formula hidrolizada • no efectivos en 2 estudios • Efectivoigualmente al placebo en 2 estudios en la reduccion de los sintomas GE • PPI’s son seguros en cortotiempo, disminuyen la acidezgastrica, y los efectosadversos son similares a bloqueadores H2 y alginatos

  16. MUCHAS GRACIAS

More Related