Gastro-oesophageal reflux in infants and children

Abstract

Gastro-oesophageal reflux is a normal physiological phenomenon that is frequently associated with regurgitation in infants. In general, it resolves by the age of one year. Some children are more likely to have persistent symptoms and develop complications, e.g. children with congenital abnormalities of the oesophagus, neurological impairment, and a family history of gastro-oesophageal reflux disease (GORD). Preliminary evidence suggests that GORD in infancy and childhood may be a precursor to adult GORD. GORD is reflux that is associated with troublesome symptoms or complications. These complications are categorised into oesophageal and extra-oesophageal difficulties. Diagnosis in most patients relies on a thorough history and physical examination. However, the symptoms in infants and young children are often atypical. Patients with significant symptoms require more extensive diagnostic assessment, such as contrast radiography, oesophagoscopy and oesophageal pH-metry. In most cases, parental reassurance and advice on feeding are sufficient. Thickened feeds reduce the frequency of regurgitation. Patients with complications require potent acid inhibition and occasionally anti-reflux surgery.