What is the clinical background of pediatric gastroesophageal reflux disease (GERD)?

Updated: Mar 14, 2019
  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Gastroesophageal reflux represents the most common gastroenterologic disorder that leads to referral to a pediatric gastroenterologist during infancy. In pediatric gastroesophageal reflux, immaturity of lower esophageal sphincter (LES) function is manifested by frequent transient lower esophageal relaxations (tLESRs), which result in retrograde flow of gastric contents into the esophagus. (See Etiology and Pathophysiology.)

Although minor degrees of gastroesophageal reflux are noted in children and adults, the degree and severity of reflux episodes are increased during infancy. Thus, gastroesophageal reflux represents a common physiologic phenomenon in the first year of life. As many as 60-70% of infants experience emesis during at least 1 feeding per 24-hour period by age 3-4 months. (See Epidemiology and Prognosis.)

The distinction between this "physiologic" gastroesophageal reflux and "pathologic" gastroesophageal reflux in infancy and childhood is determined not merely by the number and severity of reflux episodes (when assessed by intraesophageal pH monitoring), but also, and most importantly, by the presence of reflux-related complications, including failure to thrive, erosive esophagitis, esophageal stricture formation, and chronic respiratory disease. (See Prognosis, Presentation, and Workup.)

Other complications noted in adults with gastroesophageal reflux, including Barrett esophagus and esophageal mucosal dysplasia, are uncommon in childhood.


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