Gastroesophageal Reflux in Children

Gastroesophageal reflux (GER) is one of the most common reasons for primary care visits and referrals to pediatric gastroenterology. Normal, physiologic reflux is a finding seen in up to ۶۰% of infants, which decreases to ۵% by one year of age. Up to ۲۵% of infants regurgitate≥۴ times a day. The data on pediatric populations older than ۱۲ months are limited, with a prevalence determined to be ۰.۸۴ per ۱۰۰۰. It is important to distinguish between physiological regurgitation (spitting) and pathologic GERD. In GERD, there is an additional symptom, such as heartburn, epigastric pain, vomiting, inconsolable crying, hematemesis, feeding refusal, hoarseness, wheezing, disturbed sleep, and failure to thrive. Several risk factors, diseases, and abnormalities can contribute to GERD in infants. Congenital GI disorders, such as congenital diaphragmatic hernia, omphalocele, gastroschisis, esophageal atresia, and intestinal malrotation, cystic fibrosis and obesity have been reported. The diagnostic approach varies based on the child's age and reported symptoms. Initially, the child's history and physical examination findings are evaluated to identify symptoms or warning signs associated with GERD. If GERD is suspected, lifestyle changes should be considered, such as thickened feedings, dietary modifications, postural adjustments, weight loss, and avoiding secondhand smoke, overfeeding, and eating before bedtime. Progress should be monitored, and if symptoms resolve by ۱۲ months of age, no further workup is required. If symptoms do not improve, further evaluation is necessary to rule out other disorders. This evaluation may include an upper GI barium study, ultrasound, esophageal manometry, a trial of proton pump inhibitors (PPIs), scintigraphy, esophagogastroduodenoscopy, esophageal pH monitoring, and multichannel intraluminal impedance (MII). Non-pharmacological treatments are essential for managing GER and GERD in infants and children, focusing on conservative measures and dietary adjustments. Psychological interventions can significantly aid in managing GERD symptoms, particularly in children whose symptoms are exacerbated by stress or anxiety. There are two primary categories of pharmacologic treatments for GERD: (۱) Acid-suppressing agents; and (۲) Prokinetic medications. Surgery is often considered for children who have not responded to medical management, particularly those with neurologic impairments, where GERD can significantly impact their quality of life.