Pediatric gastroesophageal reflux

Gastroesophageal reflux occurs in up to 65 percent of healthy infants. The initial differentiation of physiologic reflux with harmless spitting up from pathologic reflux is often difficult to achieve. Gastroesophageal reflux is caused by transient and Intermittent lower esophageal sphincter relaxations unrelated to swallowing. Many tests are available for the diagnosis of gastroesophageal reflux, each with specific indications and limitations. Although no one test is always best, 24-hour esophageal pH monitoring remains the ''gold standard'' for diagnosis. Its major limitations are its inability to detect reflux for up to two hours following feedings because of the neutralizing effect of the feeding, the lack of correlation with clinical gastroesophageal reflux severity, the expense and the invasive nature of the test. Treatment is determined by the specific presentation. Management of physiologic reflux consists of parental reassurance and counseling about feeding and positioning techniques. Approaches to the management of pathologic reflux range from the use of histamine H-2-receptor blockers and prokinetic medications to surgery in severe cases.