Gastroesophageal Reflux Disease in Infants and Children

Tracy Sandritter, PharmD

Disclosures

J Pediatr Health Care. 2003;17(4) 

In This Article

Introduction

Gastroesophageal reflux (GER), passage of gastric materials into the esophagus, is a normal physiologic process that can progress to gastroesophageal reflux disease (GERD) when the expelled gastric materials produce undesirable symptoms and complications. It is therefore appropriate to think of GER as a normal, benign physiologic process that precedes GERD, a pathologic process (Rudolph, et al., 2001). This article will review the pathophysiology, epidemiology, symptomatology, complications, diagnostic and treatment options for pediatric patients with GER and GERD.

GER occurs frequently during the first year of life with a peak incidence of 67% at age 4 months. Also, at least one episode of reflux per day occurs in 50% of neonates who are between the ages of birth and 3 months, but infants typically outgrow this problem by one year of age (Nelson, Chen, Syniar, & Kaufer-Christoffel, 1997 & 1998). While GER is common during infancy, GERD occurs in a smaller percentage of infants (Nelson, et al., 1997; Rudolph, et al., 2001). Less is known about the incidence of GER in older children, but it is probably not as rare as it currently appears. A recent practice-based survey that looked at the health of individuals between the ages of 3 to 17 years found that 1.8-8.2% experienced symptoms of GER. This study also showed that children were less likely to receive treatment for symptoms, probably because their parents/healthcare providers were not as aware of the frequency of events. When asked by the surveyor, children, especially younger children, were more likely to report symptoms of nausea, abdominal pain, and acid regurgitation than their parents reported. Since these events are internal, parents are less likely to be aware of them compared to external events such as vomiting (Nelson, Chen, Syniar, & Kaufer-Christoffel, 2000). It is therefore important for health care providers to inquire about GER during health care visits.

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