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- Jillian S. Sullivan, MD*
- Shikha S. Sundaram, MD MSCI†
- *Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Vermont Children’s Hospital, University of Vermont College of Medicine, Burlington, VT.
- †Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Digestive Health Institute, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
Author Disclosure
Drs Sullivan and Sundaram have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
- ALTE:
- apparent life-threatening event
- GER:
- gastroesophageal reflux
- GERD:
- gastroesophageal reflux disease
- H2RAs:
- histamine-2 receptor antagonists
- LES:
- lower esophageal sphincter
- MII:
- multiple intraluminal impedance
- PPI:
- proton pump inhibitor
Educational Gap
Gastroesophageal reflux (GER) is common in healthy infants, children, and adults, but when troublesome symptoms or complications occur, the patient is said to have GER disease (GERD). Clinicians should know the diagnostic techniques for distinguishing these conditions as well as recommended management.
Objectives
After completing this article, readers should be able to:
Understand the differences between benign GER and GERD.
Understand other diseases and conditions that may mimic GERD.
Understand methods of diagnosing GERD.
Describe therapeutic options for the treatment of GERD (including lifestyle modifications, medical therapies, and surgical therapies).
Introduction
Gastroesophageal reflux (GER), defined as the passage of gastric contents into the esophagus, is a normal physiologic process in healthy infants, children, and adults but may cause distress for caregivers or patients. Gastroesophageal reflux disease (GERD) is defined as the passage of gastric contents into the esophagus that results in troublesome symptoms or complications for the infant, child, or adolescent, and not for the caregiver alone. (1) Regurgitation, commonly referred to as “spitting up,” is the effortless passage of gastric contents into the pharynx or mouth. Vomiting is the forceful expulsion of the gastric contents. In contrast, rumination is defined as voluntary, habitual, and effortless regurgitation of recently ingested food. Following this voluntary regurgitation, gastric contents are expulsed from the mouth or re-swallowed.
Epidemiology
GER is a common occurrence in healthy infants, children, and adults, most often in the postprandial period. Fifty percent of infants younger than 3 months of age and 67% of infants at 4 months of age will have at least one episode of regurgitation daily. (2) By 12 months of age, however, only 5% experience episodes of regurgitation. …
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