Sections

Sections Pediatric Gastroesophageal Reflux
Overview
Presentation
DDx
Workup
Treatment
Guidelines
Medication
Questions & Answers
Media Gallery
References

Guidelines

Clinical practice guidelines on pediatric gastroesophageal reflux by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommend the following^{[23, 24]}:

Four to eight weeks of acid-suppression therapy is recommended to treat typical reflux symptoms. This should only occur after dietary modifications in infants are unsuccessful.
Avoid acid suppression in infants and children with extraesophageal symptoms (eg, cough, wheezing, asthma).
GERD complications should be assessed with esophagogastroduodenoscopy (EGD) with biopsies.
pH/impedance studies are recommended to see the role of acid reflux in esophagitis and whether acid-suppression therapy was effective.
Diagnosing GERD with salivary pepsin, extraesophageal biomarkers, and scintigraphy is not recommended.
Only use manometry if there is suspicion of an underlying motility disorder.
Positional therapy to treat reflux in infants is not recommend.
Proton pump inhibitors can be used as treatment for erosive esophagitis.

Medication

Chao HC, Vandenplas Y. Effect of cereal-thickened formula and upright positioning on regurgitation, gastric emptying, and weight gain in infants with regurgitation. Nutrition. 2007. 23:23-28. [QxMD MEDLINE Link].
Orenstein SR. Management of supraesophageal complications of gastroesophageal reflux disease in infants and children. Am J Med. 2000. 108 (4A):139S-143S. [QxMD MEDLINE Link].
Tolia V, Gilger MA, Barker PN, Illueca M. Healing of Erosive Esophagitis and Improvement of Symptoms of Gastroesophageal Reflux Disease After Esomeprazole Treatment in Children 12 to 36 Months Old. J Pediatr Gastroenterol Nutr. 2015 Jul. 60 Suppl 1:S31-6. [QxMD MEDLINE Link].
Bhatia J, Parish A. GERD or not GERD: the fussy infant. J Perinatol. 2009 May. 29 Suppl 2:S7-11. [QxMD MEDLINE Link].
Rudolph CD. Supraesophageal complications of gastroesophageal reflux in children: challenges in diagnosis and treatment. Am J Med. 2003 Aug 18. 115 Suppl 3A:150S-156S. [QxMD MEDLINE Link].
Gieruszczak-Białek D, Konarska Z, Skórka A, Vandenplas Y, Szajewska H. No effect of proton pump inhibitors on crying and irritability in infants: systematic review of randomized controlled trials. J Pediatr. 2015 Mar. 166 (3):767-70.e3. [QxMD MEDLINE Link].
Henderson D. Proton Pump Inhibitors Do Not Ease Crying, Fussing in Infants. Medscape Medical News. Available at http://www.medscape.com/viewarticle/837588. January 06, 2015; Accessed: June 15, 2015.
Lang JE, Hossain J, Holbrook JT, Teague WG, Gold BD, Wise RA, et al. Gastro-oesophageal reflux and worse asthma control in obese children: a case of symptom misattribution?. Thorax. 2016 Mar. 71 (3):238-46. [QxMD MEDLINE Link].
Mousa H, Woodley FW, Metheney M and Hayes J. Testing the association between gastroesophageal reflux and apnea in infants. J Pediatr Gastroenterol Nutr. 2005. 41:169-177. [QxMD MEDLINE Link].
Gold BD. Gastroesophageal reflux disease: could intervention in childhood reduce the risk of later complications?. Am J Med. 2004 Sep 6. 117 Suppl 5A:23S-29S. [QxMD MEDLINE Link].
Singendonk MMJ, Brink AJ, Steutel NF, van Etten-Jamaludin FS, van Wijk MP, Benninga MA, et al. Variations in Definitions and Outcome Measures in Gastroesophageal Reflux Disease: A Systematic Review. Pediatrics. 2017 Jul 27. [QxMD MEDLINE Link].
Henderson D. Reflux guidelines: modest changes best for most infants. Mescape Medical News. April 29, 2013. [Full Text].
[Guideline] Lightdale JR, Gremse DA. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013 Apr 29. e1684-96. [Full Text].
Horvath A, Dziechciarz P, Szajewska H. The effect of thickened-feed interventions on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized, controlled trials. Pediatrics. 2008 Dec. 122(6):e1268-77. [QxMD MEDLINE Link].
Diaz DM, Winter HS, Colletti RB, et al. Knowledge, attitudes and practice styles of North American pediatricians regarding gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2007. 45:56-64. [QxMD MEDLINE Link].
[Guideline] Rudolph CD, Mazur LJ, Liptak JS et al. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr. 2001. 32:S1-S22. [QxMD MEDLINE Link].
Hassall E. Decisions in diagnosing and managing chronic gastroesophageal reflux disease in children. J Pediatr. 2005 Mar. 146(3 Suppl):S3-12. [QxMD MEDLINE Link].
Tucker ME. FDA approves pediatric formulation of proton-pump inhibitor. Medscape Medical News. March 4, 2013. Available at http://www.medscape.com/viewarticle/781615. Accessed: April 2, 2013.
Eisai Inc. FDA approves ACIPHEX Sprinkle (rabeprazole sodium) for use in children ages 1 to 11 [press release]. Available at http://us.eisai.com/view_press_release.asp?ID=129&press=396. Accessed: April 3, 2013.
Rabinowitz SS, Piecuch S, Jibali R, Goldsmith A and Schwarz SM. Optimizing the diagnosis of gastroesophageal reflux in children with otolaryngologic symptoms. Int J Pediatr Otorhinolaryngol. 2003. 167:621-626. [QxMD MEDLINE Link].
Rosen R, Lord C and Nurko S. The sensitivity of multichannel intraluminal impedance and the pH probe in the evaluation of gastroesophageal reflux in children. Clin Gastroenterol Hepatol. 2006. 4:167-172. [QxMD MEDLINE Link].
Diaz DM, Gibbons TE, Heiss K et al. Antireflux surgery outcomes in pediatric gastroesophageal reflux disease. Am J Gastroenterol. 2005. 100:1844-1852. [QxMD MEDLINE Link].
Heitlinger LA. Guideline for Management of Pediatric Gastroesophageal Reflux. JAMA Otolaryngol Head Neck Surg. 2018 Aug 1. 144 (8):755-756. [QxMD MEDLINE Link].
Boggs W. Short-Term Acid-Suppression Advised for Pediatric Gastroesophageal Reflux. Reuters Health Information. Available at https://www.medscape.com/viewarticle/899116. July 13, 2018; Accessed: December 05, 2018.

Media Gallery

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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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 Association for Physician Leadership, New York Academy of Medicine, Gastroenterology Research Group, American Gastroenterological Association, American Pediatric Society, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Andre Hebra, MD Chief Medical Officer, Nemours Children's Hospital; Professor of Surgery, University of Central Florida College of Medicine

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, 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, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Acknowledgements

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, Medscape Reference

Disclosure: Nothing to disclose.