Gastroesophageal Reflux Disease in Infants and Children

Gastroesophageal reflux is the most common esophageal disorder in children, and is responsible for heterogeneous presentations ranging from effortless regurgitation in “happy spitters” to complex esophageal and extra-esophageal GERD. The frequency and noxiousness of refluxate in proportion to the various esophageal defense mechanisms, and genetic, physiological and environmental influences ultimately determine the pathogenicity and complications of the disorder. While most children may be confidently diagnosed solely on the basis of a detailed history followed by appropriate response to therapy, diagnostic tools may be useful to clarify the role of reflux in extra-esophageal, and complicated GERD. Prompt identification and intervention for GERD in children is crucial to the prevention of strictures, Barrett’s esophagus and adenocarcinoma that are associated with long-standing reflux exposure. The first line of anti-reflux therapy in children is conservative therapy emphasizing thickened feeds, smaller volume meals, proper positioning, and elimination of smoke exposure. Proton pump inhibitor therapy has an established role in the management of those with GERD sequelae, and as empiric therapy in those with extra-esophageal GERD. Fundoplication, reserved for children who are refractory to pharmacotherapy, is being performed successfully; results of laparoscopic surgery in children are favorable with respect to shorter hospital stay, and lower complication rate than open fundoplication.