Her past medical history was negative for surgeries, hospitalizations, or major infections. Dinner was often eaten at home, and parents reported a healthy home-cooked organic diet that included meat. Lunch was the typical school hot lunch with could include pizza, spaghetti, chicken nuggets, or a sandwich. For breakfast, she usually ate toast pops or cereal with fruit. She recently restricted dairy, and although this change did not improve her pain, she described episodes where she felt particularly nauseated after eating ice cream. She reported no weight loss, normal PO intake and appetite. She denied diarrhea, fever, tenesmus, hematochezia, or pain on defecation. ![]() She had been constipated for several months, and strained often to stool. Her primary pediatrician initially started famotidine, which partially improved pain but not nausea. She reported several days of school absence in the last month. She had one episode of non-bloody, non-bilious vomiting while at summer camp, but since then has had only chronic nausea. She described the nausea as occurring almost every hour on a daily basis. Her abdominal pain was daily, 3–4/10 in intensity, and in the epigastric area. This paper will illustrate the integrative medicine approach with a case study and review the current scientific evidence on integrative medicine treatments for GERD and FD in children and adolescents.Īn 11-year old girl presented to outpatient gastroenterology clinic with abdominal pain and chronic nausea for the past month. In patients with GERD and FD, an integrative medicine treatment plan may include botanicals, mind-body techniques, sleep hygiene, increasing physical activity, and acupuncture, in addition to pharmacologic therapies. It emphasizes the powerful triad of patient-family-practitioner, is informed by evidence, and makes use of all appropriate therapies. Integrative medicine is a healing oriented medicine that takes account of the whole patient, including all elements of lifestyle and family health. Therefore, treatment of GERD and FD suggests an integrative medicine approach. ![]() Pharmacologic therapies with acid suppression do not always effectively treat symptoms related to non-erosive reflux disease and reflux symptoms from non-acidic reflux. However, acid suppressing medications have significant side effects or long-term risks that may limit their use. Histamine-2 receptor antagonists and proton pump inhibitors are often effective in healing esophagitis and treating symptoms of reflux. Treatment for GERD symptoms often includes an empiric trial of acid suppression. Dyspepsia is reported in 5%–10% of otherwise healthy adolescents. Endoscopic examination is negative in FD both grossly and microscopically. The pain or discomfort in the upper abdomen has to be present at least once per week for at least two months prior to diagnosis. Functional dyspepsia (FD) is defined by the ROME III criteria as a persistent upper abdominal pain or discomfort that: (1) is not exclusively relieved by defecation or associated with the onset of a change in stool frequency or stool form and (2) organic disease is unlikely to explain the symptoms. On upper endoscopy, GERD patients exhibit erosive esophagitis or gastritis. Symptoms of GERD include heartburn, epigastric pain, feeding difficulties, dysphagia, and aerodigestive symptoms such as asthma, chronic cough, or recurrent pneumonia. When reflux and regurgitation cause symptoms and complications, it is defined as gastroesophageal reflux disease, or GERD. Gastroesophageal reflux is the normal physiologic passage of gastric contents into the esophagus. Treatment of GERD and FD requires an integrative approach that may include pharmacologic therapy, treating concurrent constipation, botanicals, mind body techniques, improving sleep hygiene, increasing physical activity, and traditional Chinese medicine and acupuncture. Up to 70% of children with dyspepsia exhibit delayed gastric emptying. Endoscopic examination is typically negative in FD, whereas patients with GERD may have evidence of esophagitis or gastritis either grossly or microscopically. FD, as defined by the Rome III classification, is a persistent upper abdominal pain or discomfort, not related to bowel movements, and without any organic cause, that is present for at least two months prior to diagnosis. ![]() Reflux is defined as the passage of stomach contents into the esophagus, while GERD refers to reflux symptoms that are associated with symptoms or complications-such as pain, asthma, aspiration pneumonia, or chronic cough. Gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) are common problems in the pediatric population, with up to 7% of school-age children and up to 8% of adolescents suffering from epigastric pain, heartburn, and regurgitation.
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