ABSTRACT

Gastroesophageal reflux (GER) is defined as the backward flow of gastric contents into the esophagus. A common symptom complex in infants is GER, which causes parental anxiety resulting in numerous visits to the physician. Gastroesophageal reflux is a normal, common physiological process that occurs from time to time in almost everyone, of all ages, particularly after meals. It is a self-limited process in infants that usually resolves by 6 to 12 months of age. Episodes of physiological GER in healthy infants aged less than two years often are symptomatic, and regurgitation is the characteristic symptom. In most infants presenting with GER in the form of frequent regurgitation, warning signals will be absent. If the infant also has good weight gain, feeds well, and is not unusually irritable, he or she can be considered to have “uncomplicated” gastroesophageal reflux. Gastroesophageal reflux disease (GERD) is a pathological process in infants, manifested by poor weight gain, signs of esophagitis and persistent respiratory symptoms. Many tools exist for use in the workup of GERD; however, the most effective method of diagnosis is not clear. If a child is suspected of having GERD, the first step in the evaluation is a complete medical history and physical examination. The need for further testing depends upon what is found, and may rarely include one or more of the following: Esophageal pH and impedance monitoring; a pH probe is rarely useful in establishing the diagnosis of GER in infants; However, in special situations, such as infants with severe discrete episodes of symptoms (such as apnea, bradycardia, cough, or oxygen desaturation), esophageal pH monitoring may be used in conjunction with monitoring of respirations, heart rate, or oxygen saturation, radiographic; may be helpful to exclude anatomic abnormalities, and endoscopic studies; may be of benefit in patients who have not responded to dietary or empiric clinical trials and/or are suspected of having dietary protein intolerance. Conservative management involves thickened feedings, positional treatment, and parental reassurance. Most patients do not require investigation and respond either to antacid/alginates, H2 receptor antagonists, proton pump inhibitors or a combination of these treatments. Surgery is only rarely indicated. However, some children who present with reflux during infancy may ultimately require surgical management later in childhood. In this review, we update the literature with respect to clinical manifestations, diagnosis, pathophysiology and management of GER/GERD in newborn and infants. (JAREM 2011; 1: 21-5)

Keywords: Newborn, gastroesophageal reflux, gastroesophageal reflux disease