Gastroesophageal Reflux Disease Management in Pediatric Patients

Amy Wu, PharmD


US Pharmacist. 2015;40(12):28-33. 

In This Article


The commonly used diagnostic methods to evaluate pediatric patients with GERD symptoms are upper gastrointestinal (GI) tract contrast radiography, esophageal pH and/or impedance monitoring, and upper endoscopy with esophageal biopsy.[7]

The upper GI tract contrast radiography allows the practitioner to delineate anatomy and document any presence of a motility disorder. This diagnostic method involves obtaining a series of fluoroscopic images of swallowed barium until the ligament of Treitz is visualized. This is not the preferred diagnostic method to diagnose GER or GERD since the test is too brief in duration to adequately rule out the occurrence of pathologic reflux. However, the upper GI tract series is helpful in evaluating vomiting to screen for anatomic abnormalities of the upper GI tract.[2]

The esophageal pH monitoring method is used to quantify the frequency and duration of esophageal acid exposure during a study period. Despite allowing the practitioner to associate a temporal relationship between a symptom and acid reflux and to evaluate the efficacy of pharmacologic therapy on acid suppression, there is evidence suggesting poor reproducibility of pH testing.[9]

Multiple intraluminal impedance detects the movement of both acidic and nonacidic fluids, solids, and air in the esophagus, which allows a more detailed picture of esophageal events compared to pH monitoring.[9]

The upper endoscopy diagnostic method of GERD allows direct visualization of the esophageal mucosa in order to assess the presence and severity of injury from the reflux of gastric contents into the esophagus.[10] Upper endoscopy is indicated for patients with GERD who fail to respond to pharmacologic therapy or as part of initial management if the patient has symptoms of poor weight gain, unexplained anemia or fecal occult blood, recurrent pneumonia, or hematemesis. If the upper endoscopy diagnostic method is used in assessing GERD in pediatric patients, the benefits must be weighed against procedural and sedation risks.[11] Esophageal biopsy is useful in evaluating conditions that may mimic symptoms of GERD, such as Crohn's disease, Barrett's esophagus, infectious esophagitis, or eosinophilic esophagitis. Esophageal biopsies should be performed during endoscopy because endoscopic findings correlate poorly with histologic testing in infants and children.[2]