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Gastroesophageal reflux in infants

Author
Harland S Winter, MD
Section Editors
Steven A Abrams, MD
B UK Li, MD
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

The passage of gastric contents into the esophagus (gastroesophageal reflux, or GER) is a normal physiologic process that occurs in healthy infants, children, and adults. Most episodes are brief and do not cause symptoms, esophageal injury, or result in other complications. In contrast, gastroesophageal reflux disease (GERD) occurs when the reflux episodes are associated with complications such as esophagitis or poor weight gain. The range of symptoms and complications of GERD in children vary with the age of the child.

The diagnosis and management of GER in infants will be reviewed here. Reflux in premature infants, and the clinical manifestations, diagnosis, and pathophysiology of GERD in older children are discussed separately. (See "Clinical manifestations and diagnosis of gastroesophageal reflux disease in children and adolescents" and "Gastroesophageal reflux in premature infants" and "Management of gastroesophageal reflux disease in children and adolescents".)

These issues are also discussed in an official consensus statement and management guidelines issued by the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) [1], and the American Academy of Pediatrics (AAP) [2]. The full text of these guidelines is available at the NASPGHAN website (www.naspghan.org).

DEFINITIONS

In the following discussion, the term "uncomplicated" gastroesophageal reflux (GER) is used to describe the normal physiologic process of frequent regurgitation in the absence of pathological consequences. The term, "gastroesophageal reflux disease" or GERD, is used when the reflux has pathological consequences, such as esophagitis, nutritional compromise, or respiratory complications.

Strictly speaking, the term "regurgitate" describes effortless reflux up to the oropharynx or above, and "vomit" describes forceful expulsion (engaging abdominal and respiratory muscles) of the refluxate out of the mouth, but not necessarily repetitively. The terms are not clearly distinguished and often used interchangeably in clinical practice. In this review, we will use the term "regurgitate" to describe obvious GER, whether or not the refluxate comes outside of the mouth; other commonly used terms are "spitting up" or "spilling."

                                 

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Literature review current through: Nov 2016. | This topic last updated: Tue Jul 05 00:00:00 GMT 2016.
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