Gastroesophageal Reflux Disease

Vomiting and regurgitation are common occurrences in childhood. Seventy percent of 4-month-old infants regurgitate daily but only 25% of their parents consider it a problem. The challenge for physicians is to differentiate the symptoms that are physiologic and will resolve spontaneously from those that need medical or surgical intervention. Gastroesophageal refl ux disease (GERD) is defi ned as the pathologic consequences of the involuntary passage of gastric contents into the esophagus. In adults, GERD is primarily concerned with peptic esophagitis and its complications, including heartburn, esophageal stricture, and the formation of Barrett's esophagus. In children, pathologic refl ux is considerably more complex. Gastroesophageal refl ux is most commonly seen in children with neurologic dysfunction. Neurologically impaired children with GERD often have associated swallowing disorders, failure to thrive, primary aspiration, spasticity, increased intraabdominal pressure, and central mechanisms for inducing gagging and retching. Additionally, they often have associated delayed gastric emptying, dysmotility of the esophagus and upper gastrointestinal tract, and a hiatus hernia. Neurologically normal infants and children have refl ux-associated reactive airways disease, aspiration, aspiration pneumonia, laryngeal symptoms, and apnea. Sometimes this apnea is prolonged and life-threatening. Children with GERD also have digestive symptoms including frequent regurgitation with failure to thrive, irritability, food rejection, heartburn, hematemesis, melena, dysphagia, and Barrett's esophagus.