PEDIATRIC GASTROESOPHAGEAL REFLUX

Gastroesophageal reflux occurs in up to 65 percent of healthy infants. The initial differentiation of physiologic reflux with harmless spitt ing up from pathologic reflux is often difficult to achieve. Gastroeso phageal reflux is caused by transient and Intermittent lower esophagea l sphincter relaxations unrelated to swallowing. Many tests are availa ble for the diagnosis of gastroesophageal reflux, each with specific i ndications and limitations. Although no one test is always best, 24-ho ur esophageal pH monitoring remains the ''gold standard'' for diagnosi s. Its major limitations are its inability to detect reflux for up to two hours following feedings because of the neutralizing effect of the feeding, the lack of correlation with clinical gastroesophageal reflu x severity, the expense and the invasive nature of the test. Treatment is determined by the specific presentation. Management of physiologic reflux consists of parental reassurance and counseling about feeding and positioning techniques. Approaches to the management of pathologic reflux range from the use of histamine H-2-receptor blockers and prok inetic medications to surgery in severe cases.