This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
- Elizabeth A. Berg, MD*
- Julie Khlevner, MD*
- *Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Irving Medical Center, New York, NY
AUTHOR DISCLOSURE
Drs Berg and Khlevner 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.
Gastroesophageal reflux (GER) is the physiologic process of gastric contents transferring upward, past the lower esophageal sphincter (LES), and into the esophagus. GER occurs naturally in more than 25% of infants, peaks at approximately 3 to 4 months of age, and usually self-resolves with time without pathologic consequences. When reflux symptoms become severe or complications such as esophagitis, refusal to eat, or weight loss develop, GER progresses to gastroesophageal reflux disease (GERD). Intractable GERD occurs when symptoms or complications of GERD persist despite optimal medical treatment. The prevalence of GERD is less than 5% in early school-aged children and approximately 10% in children older than 10 years.
GERD is an umbrella term for a spectrum of manifestations that can be classified into categories based on symptoms, endoscopic findings, reflux monitoring, and underlying pathophysiology. The 4 major subtypes of GERD are 1) erosive reflux disease, 2) nonerosive esophageal reflux disease, 3) reflux hypersensitivity, and 4) functional heartburn. Functional heartburn is the most prevalent phenotype in children. Identifying a patient’s distinct GERD phenotype aids in selection of more effective treatment. GERD management should be based on the best available evidence, consistent with practice guidelines from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN).
Nutritional management is the mainstay of nonpharmacologic treatment of GER in infants younger than 1 year. The initial approach involves …
Individual Login
Institutional Login
You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.
Log in through your institution
Pay Per Article - You may access this article (from the computer you are currently using) for 2 days for US$25.00
Regain Access - You can regain access to a recent Pay per Article purchase if your access period has not yet expired.
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.