Diagnosis and treatment of gastro-oesophageal reflux disease in infants and children

Gastro-oesophageal reflux is a frequent, aspecific phenomenon in infants an d children. The recommended approach in infants with uncomplicated regurgit ation consists of reassurance of the parents and, if this fails, dietary re commendations in formula-fed infants. If, despite these efforts, symptoms p ersist, administration of prokinetics, such as cisapride, is recommended pr ior to investigations such as oesophageal pH monitoring. Oesophageal pH mon itoring is also recommended to document gastro-oesophageal reflux disease i n children with unusual presentations such as chronic respiratory disease. Today, cisapride is the drug of choice because it has the best efficacy and safety profile. In infants and children presenting with symptoms suggestin g oesophagitis, endoscopy of the upper gastrointestinal tract is recommende d. If there is severe oesophagitis, acid suppression with histamine H-2-rec eptor antagonists or proton pump inhibitors in combination with prokinetics , are recommended. In life-threatening situations, or in patients that are resistant to or dependent on acid-suppressive medication, a surgical proced ure such as laparascopic Nissen procedure should be considered. (C) 2000 Bl ackwell Science Asia Pty Ltd.