An infant presented with failure to thrive, stridor, otitis media and esophagitis. What is the most probable diagnosis?
**Core Concept**
Gastroesophageal reflux disease (GERD) is a condition characterized by the reflux of stomach contents into the esophagus, leading to symptoms such as esophagitis, stridor, and otitis media in infants due to aspiration.
**Why the Correct Answer is Right**
The infant's presentation of failure to thrive, stridor, otitis media, and esophagitis suggests a condition where stomach contents are leaking into the esophagus, causing irritation and inflammation. This is consistent with gastroesophageal reflux disease (GERD), which occurs when the lower esophageal sphincter (LES) fails to function properly, allowing stomach acid to flow back into the esophagus. The symptoms can be exacerbated by lying down, feeding, or other factors that increase intra-abdominal pressure. The esophagitis can lead to stridor due to aspiration of acidic contents into the airways, causing inflammation and narrowing of the airway.
**Why Each Wrong Option is Incorrect**
**Option A:** Tracheoesophageal fistula is a congenital anomaly where there is an abnormal connection between the trachea and esophagus, leading to aspiration of food and air into the lungs. While it can cause stridor and failure to thrive, it is not typically associated with otitis media.
**Option B:** Hypertrophic pyloric stenosis is a condition where the pyloric muscle thickens, causing gastric outlet obstruction and projectile vomiting. It is not typically associated with esophagitis or otitis media.
**Option C:** Duodenal atresia is a congenital anomaly where there is a blockage in the duodenum, leading to vomiting and failure to thrive. It is not typically associated with esophagitis or otitis media.
**Clinical Pearl / High-Yield Fact**
GERD is a common condition in infants, and its diagnosis can be challenging due to non-specific symptoms. A high index of suspicion and careful evaluation of symptoms, including the presence of esophagitis, stridor, and otitis media, are essential for making an accurate diagnosis.
**✓ Correct Answer: D. Gastroesophageal reflux disease**