What is the goal of medical therapy in pediatric gastroesophageal reflux?

Updated: Mar 14, 2019
  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD  more...
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The goals of medical therapy in gastroesophageal reflux are to decrease acid secretion and, in many cases, to reduce gastric emptying time. The previously described step-up approach is directed at decreasing acid content of the refluxate.

However, other components of the refluxate (eg, bile, pepsin, trypsin) may also lead to esophageal mucosal injury. These gastric fluid components may exert damaging effects even under conditions of gastric alkalinization; thus, some patients under antisecretory treatment may have normal pH probe studies and yet continue to have the symptoms of gastroesophageal reflux. [20, 21] In these cases, the development of EEI as a diagnostic tool may prove invaluable.

When rigorous step-up therapy has failed or when the complications of gastroesophageal reflux pose a short- or long-term survival risk, the goal of surgical antireflux procedures is to "tighten" the region of the LES and, if possible, to reduce hiatal herniation of the stomach (occasionally seen in patients with GERD).

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