Gastroesophageal Reflux

Objectives

After completing this article, readers should be able to:

1. Delineate the difference between physiologic reflux and gastroesophageal reflux disease.

2. Describe the signs and symptoms of reflux.

3. Discuss the methods of evaluating and diagnosing reflux.

4. Use appropriate therapies for pediatric gastroesophageal reflux disease.

Introduction

Gastroesophageal reflux is a common disorder in the pediatric population. The spectrum of symptom presentation varies substantially, and the disease manifestations can differ, depending on the patient’s age and health status. For example, a healthy 3-month-old infant can present with regurgitation in the absence of other symptoms. On the other hand, a 14-year-old child who has cerebral palsy may present with anemia, food refusal, and recurrent aspiration pneumonia. The first case is an example of physiologic gastroesophageal reflux (GER), the second of gastroesophageal reflux disease (GERD). The challenges in managing reflux lay in determining what is physiologic and what is pathologic.

GER is defined as the passage of gastric contents into the esophagus, which can be a normal physiologic process in many infants. GERD, on the other hand, is defined as symptoms or complications of GER. Regurgitation is defined as the passage of gastric contents into the oral pharynx. Vomiting is defined as expulsion of the refluxed gastric contents from the mouth. Rumination is a rare functional disorder characterized by voluntary, habitual regurgitation of stomach contents into the mouth for self-stimulation. The material can be rechewed and either reswallowed or brought out of the mouth. Rumination in infants may signify a psychiatric disorder or social deprivation.

GER is common in infancy. A report on its prevalence in 948 infants in Chicago revealed that 50% of infants ages 0 to 3 months regurgitated at least once daily, 67% at age 4 months, and 5% by age 12 months. (1) Thus, the majority of infants who have GER eventually “outgrow” …