Management of gastro-oesophageal reflux.

Parental reassurance and thickened feeds are the only requirements in the management of infants with reflux when this is the sole detectable gastro-oesophageal abnormality. In view of the strong propensity for spontaneous clinical resolution and the excellent results achieved by conservative management, infants with reflux due to a partial thoracic stomach (hiatal hernia) uncomplicated by a stricture should be treated in the first instance by postural therapy, with or without thickened feeds and supplements of antacids, domperidone, and cimetidine. Those showing no response after an adequate period of conservative treatment should have an antireflux operation. The Belsey MK IV type of fundoplication is preferred. Only an exceptional patient will require to be treated surgically before 12 months of age. The same surgical antireflux procedure, combined with oesophageal dilatations as necessary, is the treatment of choice for patients with a partial thoracic stomach complicated by a reflux oesophageal stricture. A similar treatment regimen should be followed for patients with reflux after repair of an oesophageal atresia. Surgical correction is mandatory for all infants with reflux due to a large combined hiatal hernia.