Overview
Reflux gastritis, often associated with conditions like vesicoureteric reflux (VUR), involves inflammation of the gastric mucosa due to retrograde flow of gastric contents. This condition can be asymptomatic or present with symptoms related to urinary tract involvement, particularly in pediatric populations 16.Diagnosis
Key Diagnostic Criteria: Asymptomatic or symptomatic urinary tract abnormalities, often detected prenatally or post-UTI.
Recommended Tests: Micturating Cystourethrography (MCUG) remains the reference standard 2.
Grading: VUR is typically graded (I-V), with higher grades indicating more severe reflux 12.Management
First-Line Treatments: Prophylactic antibiotics to prevent recurrent urinary tract infections 1.
Adjunctive Treatments: Surgical interventions like trigonoplasty for refractory cases 3.
Non-Surgical Options: Consideration of conscious sedation to reduce procedural distress without affecting diagnostic accuracy 5.Special Populations
Pediatrics: Prenatally diagnosed VUR often involves high-grade reflux and may have established renal defects; management decisions should consider natural history differences from post-UTI diagnosed cases 1.
Comorbidities: Voiding symptoms, breakthrough infections, and anatomical features like "golf or stadium like" ureteral orifices correlate with higher relapse rates post-surgery 3.Key Recommendations
For asymptomatic infants with prenatally diagnosed VUR, active management decisions should weigh the natural history and potential renal impact, acknowledging limited evidence on long-term outcomes without intervention (Evidence: Moderate 1).
Interactive Magnetic Resonance voiding cystourethrography (iMRVC) can serve as a radiation-free alternative for evaluating VUR in infants, showing high sensitivity but with some false positives (Evidence: Moderate 2).
Trigonoplasty success rates may decrease with prolonged follow-up; factors predicting relapse include voiding symptoms, history of breakthrough infections, and specific ureteral orifice appearances (Evidence: Moderate 3).
Conscious sedation with oral midazolam effectively reduces procedural distress in children undergoing VCU without compromising diagnostic accuracy for VUR (Evidence: Strong 5).References
1 Farrugia MK, Montini G. Does vesicoureteric reflux diagnosed following prenatal urinary tract dilatation need active management? A narrative review. Journal of pediatric urology 2025. link
2 Arthurs OJ, Edwards AD, Joubert I, Graves MJ, Set PA, Lomas DJ. Interactive magnetic resonance voiding cystourethrography (iMRVC) for vesicoureteric reflux (VUR) in unsedated infants: a feasibility study. European radiology 2011. link
3 Basiri A, Kashi AH, Simforoosh N, Sharifiaghdas F, Halimi-Asl P, Inanlu SH. Success of trigonoplasty anti-reflux surgery and its predictive factors. Urologia internationalis 2010. link
4 Baumer JH. Can we predict vesicoureteric reflux?. Archives of disease in childhood 2006. link
5 Herd DW, McAnulty KA, Keene NA, Sommerville DE. Conscious sedation reduces distress in children undergoing voiding cystourethrography and does not interfere with the diagnosis of vesicoureteric reflux: a randomized controlled study. AJR. American journal of roentgenology 2006. link
6 Wiggelinkhuizen J, Retief PJ. Familial vesico-ureteral reflux. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1977. link