Gastro-oesophageal reflux: Clinical profiles and outcome

Objectives: To assess the clinical features, investigations and outcome of 69 children (40 males, 29 females) with gastrooesophageal reflux (GOER) ref erred to a tertiary referral centre in paediatric gastroenterology. Methods: A study of all patients with significant GOER seen at the Paediatr ic Gastroenterology Unit, Queen Elizabeth Hospital for Children, Hackney Ro ad, London, between December 1994 and August 1995. Results: The median age at referral was 16 months. Presenting symptoms were recurrent vomiting (72%), epigastric and abdominal pain (36%), feeding dif ficulties (29%), failure to thrive (28%) and irritability (19%). Continuous 24-h lower oesophageal pH studies performed in 57 children showed 20 (35%) had a reflux index of between 10% to 20%, 14 (25%) had a index >20%, and s ix (11%) had a postprandial reflux index >10%. Reflux was shown in 38 (62%) of 62 children who underwent barium studies. None had significant anatomic al abnormalities, but in the 22 children who had a negative barium studies, six had severe reflux (reflux index > 20%). Upper gastrointestinal endosco py performed in 47 children showed reflux oesophagitis in 29 (62%), oesopha geal ulceration in three, and Barrett's oesophagus in one. All of the child ren were treated with standard medical therapy. Sixty-six per cent were abl e to discontinue medication within 12 months and remained well. Four childr en (6%) required Nissen's fundoplication for failure to respond to medical therapy. Conclusions: Most infants with GOER have an uncomplicated course. False neg ative results were noted in both pH monitoring and barium meal. Up to 80% o f children, with therapy, will improve within 12 months.