What is the prognosis 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

During infancy, the prognosis for gastroesophageal reflux resolution is excellent (although developmental disabilities represent an important diagnostic exception); most patients respond to conservative, nonpharmacologic treatment.

Indeed, most cases of gastroesophageal reflux in infants and very young children are benign, and 80% resolve by age 18 months (55% resolve by age 10 mo), although some patients require a “step-up” to acid-reducing medications. Symptoms that persist after age 18 months suggest a higher likelihood of chronic gastroesophageal reflux; in such cases, the long-term risks of the condition are increased. [10]

In refractory cases of gastroesophageal reflux or when complications related to reflux disease are identified (eg, stricture, aspiration, airway disease, Barrett esophagus), surgical treatment (fundoplication) is typically necessary. The prognosis with surgery is considered excellent. The surgical morbidity and mortality is higher in patients who have complex medical problems in addition to gastroesophageal reflux.

As previously mentioned, children with neurodevelopmental disabilities, including cerebral palsy, Down syndrome, and other heritable syndromes associated with developmental delay, have an increased prevalence of gastroesophageal reflux. When these disorders are associated with motor abnormalities (particularly spastic quadriplegia), medical gastroesophageal reflux management is often particularly difficult, and suck and/or swallow dysfunction is often present. Infants with neurologic dysfunction who manifest swallowing problems at age 4-6 months may have a very high likelihood of developing a long-term feeding disorder.

Despite the immense volume of data examining diagnosis, management and prognosis related to pediatric gastroesophageal reflux, a recent review of 46 articles (out of more than 2400 publications identified) demonstrated wide variations and inconsistencies in definitions, management approaches and in outcome measures. [11]


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