Gastroesophogeal reflux (GER) & gastroesophogeal reflux disease (GERD) in children- management guidance
An excellent extensive (and "must read" Ed.) "Clinical Report" from the AAP "Section on Gastroenterology, Hepatology and Nutrition" outlines the latest evidence based approach to the diagnosis and management of childhood GER and GERD. Differentiating between GER and GERD is fundamental to management approaches.
GER is considered a normal physiological process that occurs with the passage of food between stomach and esophagus, several times a day in healthy infants, children and adults. This non-pathologic reflux may commonly be associated with vomiting and/or regurgitation, with no other history and physical examination abnormality. Life-style conservative treatment (without medications) is usually all that is required and resolution generally occurs by 18 months of age (in the infant).
GERD includes symptoms and complications associated with GER and are classified as either:
1. Esophageal including: vomiting, poor weight gain, dysphagia, epigastric or substernal/retro-sternal pain (heartburn) and esophagitis and "sour burps".
2. Extraesophageal including: Respiratory symptoms, dental erosions, pharyngitis, sinusitis and recurring otitis media.
Diagnostic studies, life-style changes, medications (acid suppressants and prokinetic agents) and surgery (for children with intractable symptoms) are fully discussed.