Ujjal Poddar1. 1. a Department of Paediatric Gastroenterology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India.
Abstract
BACKGROUND: Gastro-oesophageal reflux (GER) and gastro-oesophageal reflux disease (GERD) are common in infants and children. AIMS: To review the recent literature on GERD in children and to outline the approach to diagnosis and management. METHODS: A literature search in PubMed was conducted with regard to the prevalence, clinical features, diagnosis and management of GER and GERD in children with special attention to low- and middle-income countries. Articles in English published during the last 25 years, the full text of which was available, were considered and the relevant information extracted. RESULTS: Almost 50% of all healthy infants regurgitate at least once a day which peaks at 4 months of age and subsides by 12 months in 90% of cases. Conversely, the prevalence of GERD increases with age and, by adolescence, is similar to that in adults (20%). While GER in infancy does not require investigation or therapy, an empirical proton pump inhibitor (PPI) for 4-8 weeks is justified in older children with classical symptoms of GERD. There is no gold-standard investigation for GERD. In extra-oesophageal manifestations, a pH/impedance is useful and endoscopy in cases with oesophagitis. PPIs play a pivotal role in the management of GERD but have not been found useful in infants with GER. Anti-reflux surgery plays a minor role in GERD owing to the associated morbidity and high failure rate, especially in high-risk groups who most need it. CONCLUSIONS: Unless there are warning features such as failure to thrive, haematemesis, abnormal posturing, choking/gagging or coughing while feeding, regurgitation in infancy need not be investigated. In older children and adolescents with typical reflux symptoms, empirical PPI therapy is justified. For extra-oesophageal manifestations, a pH/impedance study and endoscopy to detect oesophagitis are the investigations of choice. PPI is the mainstay of therapy in GERD, but not in GER.
BACKGROUND: Gastro-oesophageal reflux (GER) and gastro-oesophageal reflux disease (GERD) are common in infants and children. AIMS: To review the recent literature on GERD in children and to outline the approach to diagnosis and management. METHODS: A literature search in PubMed was conducted with regard to the prevalence, clinical features, diagnosis and management of GER and GERD in children with special attention to low- and middle-income countries. Articles in English published during the last 25 years, the full text of which was available, were considered and the relevant information extracted. RESULTS: Almost 50% of all healthy infants regurgitate at least once a day which peaks at 4 months of age and subsides by 12 months in 90% of cases. Conversely, the prevalence of GERD increases with age and, by adolescence, is similar to that in adults (20%). While GER in infancy does not require investigation or therapy, an empirical proton pump inhibitor (PPI) for 4-8 weeks is justified in older children with classical symptoms of GERD. There is no gold-standard investigation for GERD. In extra-oesophageal manifestations, a pH/impedance is useful and endoscopy in cases with oesophagitis. PPIs play a pivotal role in the management of GERD but have not been found useful in infants with GER. Anti-reflux surgery plays a minor role in GERD owing to the associated morbidity and high failure rate, especially in high-risk groups who most need it. CONCLUSIONS: Unless there are warning features such as failure to thrive, haematemesis, abnormal posturing, choking/gagging or coughing while feeding, regurgitation in infancy need not be investigated. In older children and adolescents with typical reflux symptoms, empirical PPI therapy is justified. For extra-oesophageal manifestations, a pH/impedance study and endoscopy to detect oesophagitis are the investigations of choice. PPI is the mainstay of therapy in GERD, but not in GER.