Reflux esophagitis in children with feeding problems: A preliminary study

  • Lia Mulyani Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Badriul Hegar Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Alan R. Tumbelaka Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
  • Ening Krisnuhoni Department of Pathology Anatomy, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Keywords: feeding problems, reflux esophagitis, regurgitation, vomitus


Background Untreated gastroesophageal reflux can cause reflux esophagitis, a condition characterized by damage to the esophageal mucous layer due to exposure to caustic gastric contents. Manifestation of esophagitis in young children include feeding

problems, irritability, and backô€€³arching. Persistent esophagitis may cause growth failure, gastric bleeding, and anemia. Reflux esophagitis should be considered an etiology of feeding problems, especially in children with a history of gastroesophageal reflux during infancy.

Objective The purpose of this study is to detennine the prevalence of reflux esophagitis in children with feeding problems.

Methods A cros-sectional study was done in November 2007 to April 2008. Children under 5 years of age with feeding problems and a history of regurgitation or vomiting started from age 6 months or more underwent endoscopy and biopsy examinations. Reflux esophagitis was diagnosed based on the Los Angeles classification of endoscopic examination.

Results Reflux esophagitis was diagnosed in 18 of 21 children with feeding problems and a history of regurgitation or vomiting. Most subjects were boys aged 12 to36 months. Feeding problems has lasted for more than 6 months, regurgitation or vomiting

for more than 12 months, and suffered from mild malnutrition. Vomiting was observed to be a common symptom in children with reflux esophagitis.

Conclusion The prevalence of reflux esophagitis in children with feeding problems and a history of regurgitation or vomiting started from age ≥ 6 months is high, therefore it will influence treatment.


1. Hegar B, Vandenplas Y. Gastro-oesophageal reflux in infancy. J Gastroenterol Hepatol. 1999;14:13-9.
2. Vandenplas Y. Reflux esophagitis in infants and children: a report from the working group on gastroesophageal reflux disease of the European Society of Paediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 1994;18:413-22.
3. Hegar B. Refluks gastro􀁨esofagus pada anak. Presented at 12th National Congress of Child Health and 11th Asean Pediatric Federation Conference; 2002 June 3- July 4; Bali, Indonesia.
4. Vandenplas Y, Hegar B. Diagnosis and treatment of gastro􀁨oesophageal reflux disease in infants and children. J Gastroenterol Hepatol. 2000; 15:59-603.
5. Salvatore S, Vandenplas Y. Gastro􀁨oesophageal reflux disease and motility disorders. Best Pract Res Clin Gastroenterol. 2003;17:163-79.
6. Vandenplas Y, Hegar B. Esophagitis ini children. In: Trihono Pp, Pudjiarto PS, SyarifDR, Hegar B, Gunardi H, Oswari H, et al, editors. Hot topics in pediatrics II. Jakarta: Balai Penerbit F KUI; 2002. p. 74-83.
7. Orlando RC. Reflux esophagitis. In: Yamada T, editor.Textbook of gastroenterology. 2nd ed. Philadelphia: Lippincott Company; 1995. p. 1214-41.
8. Hamilton SR. Reflux esophagitis and Barrett esophagus. In: Goldman H, Appelman HD, Kaufman N, editors. Gastrointestinal pathology. Baltimore: Williams & Wilkins; 1990. p. 11-29.
9. Hogan WJ, Dodds WJ. Gastroesophageal reflux disease (reflux esophagitis). In: Wickland E, editor. Gastrointestinal disease. 4th edition. Philadelphia, WB Saunders; 1989. p. 594-616.
10. Chu AS. Esophagitis. [cited 2004 Sep 9]. Available from,
11. Spechler SJ. Gastroesophageal reflux disease and its complications. In: GrendellJH, McQuaid KR, Friedman SL, editors. Current diagnosis and treatment in gastroenterology. USA Appleton and Lange; 1996. p. 245-60.
12. El􀁨Serag HB, Bailey NR, Gilger M, Rabeneck L. Endoscopic manifestations of gastroesophageal reflux disease in patients between 18 months and 25 years without neurological deficits. Am J Gastroenterol. 2002;97: 163-9.
13. Hegar B, Finnansyah A. Diagnosis refluks gastroesofagus pada anak. Maj Kedokt Indones. 1999;49:70-4.
14. Salvatore S, Hauser B, Vandenplas Y. The natural course of gastro􀁨oesophageal reflux. Acta Paediatr. 2004;93 :106-9.
15. Aw M. Pediatric gastr-oesophageal reflux disease (GERD) – a relook at a connnon problem. Singapore: National University hospital; 2003.
16. Vieira MC, Pisani JC, Mulinari RA. Diagnosis of reflux esophagitis in infants: histology of the distal esophagus must complement upper gastrointestinal endoscopy. J Pediatr. 2004;80:197-202.
17. Lundell LR, Dent j, Bennett jR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45: 17-80.
18. Samsudin. Penyebab dan tata laksana kesulitan makan. Presented at 2nd Periodic Scientific Meeting Indonesian Pediatric Society; 1992; Yogyakarta, Indonesia.
19. Palmer S, Horn S. Feeding problem in children. In: Palmer S, Ekvall S, editors. Pediatric nutrition in developmental disorders. Springfield: Charles C. T homas publisher; 1978. p. 107-29.
20. Bonnin AC. Feeding problem of infant and toddlers. Can Fam Physic. 2006;52:1247-51.
21. Nasar SS. Masalah makan pada anak. In: Pulungan AB, Hendarto A, Hegar B, Oswari H, editors. Nutrition growth development. Jakarta: Indonesian Pediatric Society; 2006. p. 53-68.
22. Amirani DE Kesulitan makan pada anak prasekolah usia 4-6 tahun: prevalens, karakteristik, antropometris dan keluarga [thesis]. Jakarta: University of Indonesia; 1998.
23. Rommel N, Meyer AM, Feenstra L, Wauters GY. T he complexity of feeding problems in 700 infants and young children presenting to a tertiary care institution. J Pediatr Gastroenterol Nutr. 2003;37:7-84.
24. Hegar B, Boediarso A, Firmansyah A, Vandenplas Y. Investigation of regurgitation and other symptoms of gastroesophageal reflux in Indonesian infants. World J Gastroenterol. 2004; 10:1795-7.
25. Nelson Sp, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during infancy. Arc Pediatr Adolese Med. 1997;15:1169-72.
26. Nelson Sp, Chen EH, Syniar GM, Christoffel KK. One-year follow-up of symptoms of gastroesophageal reflux during infancy. Pediatrics. 1998;102:1A.
27. Nelson Sp, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during childhood. Arc Pediatr Adolese Med. 2000; 154:150-4.
28. Mittal RK. Pathophysiology of gastroesophageal reflux: motility factors. J Gastroenterol. 2003;38:7-12.
29. Davidson Gp, Omari TI. Pathophysiological mechanisms of gastroesophageal reflux disease in children. Gastroenterology. 2001;3,257-62.
30. Yoshida N, Yoshikawa T. Defense mechanism of the esophageal mucosa and esophageal inflammation. J Gastroenterol. 2003:38:31-34.
31. Orel R, Marcovic S. Bile in the esophagus: a factor in the pathogenesis of reflux esophagitis in children. J Ped Gastroenterol Nutr. 2003;36:172-4.
32. Hyman PE. Gastroesophageal reflux: one reason why baby won't eat. J Pediatr. 1994:125:SI03-9.
33. Mathisen B, Worrall L, Masel j, Wall C, Shepherd RW. Feeding problems in infants with gastro-oesophageal reflux disease: A controlled study. J Paediatr Child Health. 1999:35:163-9.
34. Martin JA, Pratt N, Kennedy JD, Ryan P, Ruffin R, Miles H, et al. Natural history and familial relationships of infant spilling to 9 years of age. Pediatrics. 2002;109:1061-7.
35. Gold BD. Gastroesophageal reflux disease: could intervention in childhood reduce the risk of later complications? Am J Med. 2004:117:S23-7.
36. Gold BD. Review article: epidemiology and management of gastro-oesophageal reflux in children. Aliment Phannacol Ther. 2004:19:22-7.
37. Rudolph CD, Mawr Lj, Liptak GS, Baker RD, Boyle JT, Colletti RB, et al. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations for the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroentrol Nutr. 2001:32(Suppll):SI-31.
38. Bronner MP. Inflammatory disorders of the esophagus.Available from: http:// Cited 2004 Dec 9.
39. Esposito S, Valente G, Zavallone A, Guidali P, Rapa A, Oderda G. Histological score for cells 'With irregular nuclear contour for the diagnosis of reflux esophagitis in children. Hum Path. 2004:35:96-100.
40. Cohen R C , O ' Loughlin EV, Davidson GF, Moore DJ, Lawrence DM. Cisapride in the control of symptoms in infants 'With gastroesophageal reflux: a randomized, double-blind, placebo-controlled trial. j Pediatr. 1999: 134:287-92.
41. DeVault KR, Castell DO. Update guidelines for diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 1999:94:1434-42.
42. Zimmennann AE, Walters JK, Katona BG, Souney PF, Levine D. A review of omeprazole use in the treatment of acid-related disorders in children. Clin Ther. 200 1;23:660-79.
43. Israel DM, Hassall E. Omeprazol and other proton inhibitors: phannacology, efficacy and safety, 'With special reference to use in children. J Pediatr Gastroenterol Nutr. 1998;27:568-79.
44. Karjoo M, Kane R. Omeprazol treatment of children with peptic esophagitis refractory to ranitidine therapy. Arch Pediatr Adolesc Med. 1995:149:267-71.
45. Vigneri S, Termini R, Leandro G, Badalamenti S, Pantalena M, Savarino V, et al. A comparison of five maintenance therapies for reflux esophagitis. N Engl j Med. 1995 :333: 1106-10.
46. Madrazo-de la Garza A, Dibildox M, Vargas A, Delgado J, Gonzalez J, Yanez P. Efficacy and safety of oral pantoprazol 20 mg given once daily for reflux esophagitis in children. J Pediatr Gastroenterol Nutr. 2003;36:261-5.
47. Christensen ML, Gold BD. Clinical management of infant and children 'With gastroesophageal reflux disease: disease recognition and therapeutic options. Proceedings of American Society of Health􀁪system Pharmacist Midyear Clinical Meeting; 2002 Dec 9; Atlanta, Georgia. p.1-11.
48. Gibson RS. Principles of nutritional assessment. New York: Oxford university press; 1990. p. 163-86.
49. Samsudin, Soedibjo S. Penilaian keadaan gizi dan pertumbuhan: cara, kegunaan, dan keterbatasan. In: Samsudin, Nasar SS, Sjarif DR, editor. Masalah gizi ganda dan tumbuh kembang anak. Proceedings of 35th Pediatric Continuing Professional Development. Jakarta: Indonesian Pediattic Society: 1995. p. 149-58.
50. Wikipedia: the free encyclopedia. [cited 2005 Sep 9]. Available from:
51. Dadhich SK, Yachha SK, Srivastava A, Sikora SS, Pandey R. Endoscopic and histologic evaluation of reflux esophagitis. Indian Pediatr. 2000:37:1111-4.
52. Drent LV, Pinto EALC. Feeding disorders in children 'With gastro􀁪esophageal reflux disease. Pro Fono. 2007 ;19:59-66.
53. Vandenplas Y. Reflux esophagitis: biopsy or not? J Pediatr Gastroenterol Nutr. 1996;22:326-7.
How to Cite
Mulyani L, Hegar B, Tumbelaka A, Krisnuhoni E. Reflux esophagitis in children with feeding problems: A preliminary study. PI [Internet]. 30Oct.2010 [cited 21Apr.2024];50(5):284-0. Available from:
Received 2016-11-03
Accepted 2016-11-03
Published 2010-10-30