Chapter 12

• Gastroesophageal reflux (GER) frequently resolves most commonly by 1 year of age. However, gastroesophageal reflux disease (GERD) can become a chronic condition in some children.

• Regurgitation is the predominant symptom in infantile GERD. In older children, abdominal pain predominates. Both groups can present with extraesophageal symptoms (e.g., respiratory manifestations).

• GERD is optimally diagnosed by clinical suspicion and a response to therapy (i.e., most frequently acid suppression), but diagnostic testing such as upper endoscopy may be indicated to assess for GERD-related complications and/or its mimics (e.g., eosinophilic esophagitis).

• Conservative and lifestyle measures may be adequate to treat uncomplicated, mild GERD in infants, and should be employed in older children and adolescents with GERD, even in the face of pharmacological and/or surgical therapy.

Gastroesophageal reflux (GER) refers to the passage of gastric contents into the esophagus or oropharynx, with or without vomiting.1,2 GER can be a daily, normal physiological occurrence in infants, children, and adolescents. Most episodes of GER in healthy individuals last <3 minutes, occur in the postprandial period, and cause few or no troublesome symptoms. Regurgitation or “spitting up” is the most obviously visible symptom. It is characterized by effortless emesis and is seen particularly in a very young child, occurring daily in about 50% of infants <3 months of age. Regurgitation resolves spontaneously in most healthy infants by 12–14 months of age.3,4 Reflux episodes sometimes trigger vomiting: the forceful expulsion of gastric contents from the mouth. Vomiting associated with GER is thought to be the result of stimulation of pharyngeal sensory afferents by refluxed gastric contents. Rumination refers to the effortless regurgitation of recently ingested food into the mouth with subsequent mastication and re-swallowing. Rumination syndrome is a distinct clinical entity with regurgitation of ingested food within minutes following meals due to the voluntary contraction of the abdominal muscles.

Gastroesophageal reflux disease (GERD) refers to the symptoms and complications that may develop secondary to persistent GER.1,2 Differentiating GER from GERD is critical for the clinician in order to avoid unnecessary diagnostic testing and exposure to medications. Recently, there have been three critically important publications1,2,5 that offer the clinician a complete characterization of the evidence-based definitions of GER and GERD, particularly GERD-related complications as well as the diagnostic and therapeutic approach to the child with GERD. Complications of GERD in children include esophagitis, growth disturbance, and feeding aversion as well as extraesophageal disease such as respiratory disorders. The first of the two “definition” publications was the Montreal definition of GERD in adults published by Vakil et al. in 2006,5 and the second, using similar methodology for the establishment of the definitions, was the Global evidence-based consensus on the definition of GERD in children (Figures 12–1 and 12–2)1 Shortly thereafter, a joint committee of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the European Society for Gastroenterology, Hepatology and Nutrition (ESPGHAN) published recommendations for the management of children with reflux.2

###### FIGURE 12–1

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

## Subscription Options

### AccessPediatrics Full Site: One-Year Subscription

Connect to the full suite of AccessPediatrics content and resources including 20+ textbooks such as Rudolph’s Pediatrics and The Pediatric Practice series, high-quality procedural videos, images, and animations, interactive board review, an integrated pediatric drug database, and more.