Gastroesophageal Reflux Disease Management in Pediatric Patients

Amy Wu, PharmD


US Pharmacist. 2015;40(12):28-33. 

In This Article

Abstract and Introduction


Guidelines from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition define the difference between gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD). Accurate distinction is important in the pediatric population in order for clinicians to determine which patients should be conservatively treated with lifestyle modifications or receive pharmacologic management. The use of acid-suppressant therapy (histamine2-receptor antagonists and proton pump inhibitors) is recommended in pediatric patients with persistent symptoms of GERD.


Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus, which is associated with transient relaxations of the lower esophageal sphincter (Figure 1).[1,2] This occurs in more than two-thirds of otherwise healthy infants and can happen several times a day in healthy infants, children, and adults. In healthy adults, GER occurs postprandial, lasts <3 minutes, and causes few or no symptoms.[3] However, less is known regarding the physiology of GER in pediatrics, but the most visible symptom is regurgitation or spitting up, which occurs daily in 50% of all infants. Gastroesophageal reflux disease (GERD) is defined as troublesome symptoms or complications associated with GER.[2]

Figure 1.

The lower esophageal sphincter (LES) tightens after swallowing is complete and keeps the contents of the stomach from reentering the esophagus. For those with gastroesophageal reflux, the LES may not tighten enough to prevent reflux. The acid that refluxes back into the esophagus can cause vomiting or heartburn.
Source: Reference 1.

Symptoms or conditions associated with GERD are classified into two categories, esophageal or extraesophageal.[2] Esophageal conditions include vomiting, poor weight gain, abdominal or substernal/retrosternal pain, esophagitis, and dysphagia. Extraesophageal conditions that are established manifestations of GERD include respiratory symptoms such as cough, laryngitis, and wheezing in infancy.[4]