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Gastroesophageal Reflux

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Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

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Abstract

The guidelines of the North American and European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN/ESPGHAN) define gastroesophageal reflux (GER) as the physiologic passage of gastric contents into the esophagus and GER disease (GERD) as reflux associated with troublesome symptoms or complications. Although there is overlap between GER and GERD, their recognition is important to implement best management practices across all pediatric age groups. Clinical manifestations of GER and GERD in term infants, children, and adolescents allow to identify patients who can be managed with conservative treatment and to refer patients who require diagnostic workup. History and physical examination remain cornerstones and are important to rule out differential diagnoses. Endoscopy and histology remain the preferred diagnostic tool for esophagitis and allow also the diagnosis of eosinophilic esophagitis. Esophageal impedance measures more reflux episodes than pH-metry and therefore allows us to better evaluate a time association between symptoms and GER. However, as long as there is no effective prokinetic drug, the practical implications of measuring nonacid or weakly acid GER remain limited. Conservative recommendations such as reassurance, dietary, and positional treatment are the indicated therapy in those with uncomplicated physiologic but troublesome regurgitation. In infants, GER(D) may be difficult to distinguish from cow’s milk protein allergy as presenting symptoms may be very similar. Children with (acid) GERD may benefit from diagnostic evaluation and medical (antiacid) treatment with laparoscopic surgery for the more severe cases. Medications are explicitly indicated only for patients with GERD. There is an increasing inappropriate prescription rate for proton pump inhibitors in infants, especially when presenting with inconsolable crying. Surgical therapies are reserved for children with intractable symptoms or who are at risk for life-threatening complications of GERD.

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Abbreviations

BAL:

Bronchoalveolar liquid

CMPA:

Cow’s milk protein allergy

ENT:

Ear–nose–throat

GER(D]:

Gastroesophageal reflux (disease]

H2 RA:

H2 receptor antagonist

LES:

Lower esophageal sphincter

LLM:

Lipid laden macrophages

NERD:

Non-erosive reflux disease

PPI:

Proton pump inhibitor

TLESR:

Transient lower esophageal sphincter relaxation

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  1. Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium

    Yvan Vandenplas

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  1. Department of Pediatrics, University of Chicago, Chicago, Illinois, USA

    Stefano Guandalini

  2. Clinical Director Child Health King’s College Hospital, Professor and Director Pediatric Liver, GI and Nutrition Center, London, United Kingdom

    Anil Dhawan

  3. Department of Pediatrics, Hebrew University Hadassah Hospital, Jerusalem, Israel

    David Branski

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Vandenplas, Y. (2016). Gastroesophageal Reflux. In: Guandalini, S., Dhawan, A., Branski, D. (eds) Textbook of Pediatric Gastroenterology, Hepatology and Nutrition. Springer, Cham. https://doi.org/10.1007/978-3-319-17169-2_10

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