Pediatric Gastroesophageal Reflux Differential Diagnoses

  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD   more...
 
Updated: May 3, 2012
 
 

Diagnostic Considerations

Vomiting is a symptom associated with many disorders. Accordingly, gastroesophageal reflux cannot be assumed to be the primary problem in infants and children who present with a history of emesis. Warning signals that herald the requirement for additional evaluation include the following:

  • Bilious or forceful vomiting
  • Hematemesis or hematochezia
  • Vomiting with diarrhea
  • Abdominal tenderness or distention
  • Onset of vomiting after 6 months of life
  • Fever, lethargy, hepatosplenomegaly
  • Macrocephaly, microcephaly, seizures

The occurrence of any of these signs and symptoms indicates the need to consider a comprehensive metabolic, neurologic, and/or surgical evaluation, in addition to a gastroenterologic workup.

Conditions to consider in the differential diagnosis of gastroesophageal reflux include the following:

  • Antral web
  • Intestinal motility disorders
  • Irritable bowel syndrome
  • Peptic ulcer disease
  • Sudden infant death syndrome
  • Tracheoesophageal fistula

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Coauthor(s)

Andre Hebra, MD  Chief, Division of Pediatric Surgery, Professor of Surgery and Pediatrics, Medical University of South Carolina College of Medicine; Surgeon-in-Chief, Medical University of South Carolina Children's Hospital

Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Children's Oncology Group, Florida Medical Association, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, and Southern Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD  Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Additional Contributors

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Director, Pediatric Fellowships and Gastroenterology Fellowship, Medical Director, Functional Gastrointestinal Disorders and Cyclic Vomiting Program, Medical College of Wisconsin; Attending Gastroenterologist, Children's Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, and North American Society for Pediatric Gastroenterology and Nutrition

Disclosure: Nothing to disclose.

Jennifer DA Liburd, MD, Consulting Staff, Assistant Professor of Pediatrics, Department of Pediatric Emergency Medicine, Nyack Hospital

Jennifer DA Liburd, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Jayant Deodhar, MD Associate Professor in Pediatrics, BJ Medical College, India; Honorary Consultant, Departments of Pediatrics and Neonatology, King Edward Memorial Hospital, India

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

References

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The image is a representation of concomitant intraesophageal pH and esophageal electrical impedance measurements. The vertical solid arrow indicates commencement of a nonacid gastroesophageal reflux episode (diagonal arrow). The vertical dashed arrow indicates the onset of a normal swallow.
Algorithm for evaluation and "step-up" management of gastroesophageal reflux (GER).
Illustration of the Nissen fundoplication. Note how the stomach is wrapped around the esophagus (360-degree wrap).
 
 
 
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