Need Answers Please On Erosive Esophagitis!!!!

  
  : My daughter is 19 months old and has had a reflux problem since birth. She has been on Zantac and Propulsid for
  the past 19 months with no signs of helping.
  : She just had an upper endoscopy and a biopsy showed that she had esophagitis. What exactly is this and how serious
  is this to treat? She is now on Prilosec for this
  : problem. She is still vomiting and when she does, she is bringing up foods from the previous day and they aren't
  digested much. She is scheduled for a Gastric Emptying Scan.
  : It there a link between having problems digesting food and the reflux in her esophagus. What could be causing the
  stomach to not digest food when she has an over abundance of acid?
  : Any information will be appreciated and very helpful.
  : Thank You,
  : Michelle

Dear Michelle:
There's a strong link between esophagitis and GERD. Esophagitis is defined as the inflammation of the esophagus , in your daughter's case , due to the GERD and the reflux of acid into the esophagus.
GERD is usually physiologic ( no bad effects) , occasionally GERD can cause complications ( pathological GERD) , some of which include erosive esophagitis, aspiration pneumonia and failure to thrive.
The esophageal mucous lining is not adapted to take high concentrations of acid from the stomach , we usually have several defence mechanisms to prevent the reflux of acid into the esophagus :
1. The lower esophageal sphincter : works as a gateway at the esophageal-stomach junction by contrating during acid digestion of food in the stomach.
2. Increased intragastric( stomach) pressure, allows the pressure gradient on either side of the sphincter to be imbalanced , causing reflux.
3. The presence of a hiatal hernia , which is a herniation of the the upper part of the stomach into the thorax( above the diaphragm : the muscle between the abdomen and chest) impairing the function of the shincter.
4.  Neurological impairment,as in cerebral palsy , feeding through a nasogastric or gastrostomy tube , with altered motility patterns of the upper gastrointestinal tract. GERD in these children are often difficult to control and may require more than medical means to relieve the symptoms.
The best approach to GERD ( and thereby reducing the recurrence of esophagitis) is by positioning the infant or child in an upright with head elevated 20-30 degrees, frequent small volume feeds , thicken in infants with cereal, antacids and agents that cause increased gastric motility , acid blockers ( zantac or cimetidine as first line drugs , then famotidine, omeprazole-prilosec maybe tried) . Other alternatives may include ( in refractory cases , failure of medical treatment , severe esophagitis , failure to thrive , Barrett's esophagus , intractable esophagitis symptoms in an older child : fundoplication or a gastrojejunal feeding device).
The gastric emptying scan will help delineate the time it takes for the stomach contents to be evacuated and help to identify any aspiration     associated with reflux into the airways .
I hope this answers some of your concerns

Disclaimer : This information is provided for educational purposes.
Keywords : esophagitis*( gastroenterology) , GERD* ( gastroenterology)