Reflux in children

Gastro-oesophageal reflux (GOR) is an extremely common paediatric problem t hat often runs a harmless and self-limited course. Physiological GOR howeve r can lead to marked parental anxiety, many unnecessary investigations and often unwarranted and potentially harmful therapeutic interventions. Our ab ility to better define GOR and gastro-oesophageal reflux disease (GORD) has improved in the past 15 years with a better understanding of the pathophys iology in infants and children due to the development and wider use of flex ible endoscopy, 24-hour oesophageal pH monitoring and, more recently, the u se of micromanometric methods for studying oesophageal motility. This will be further enhanced in the future with the development of non-invasive brea th testing to study gastrointestinal motility and the use of electrical imp edance to study fluid movement. Our therapeutic interventions have also imp roved particularly in the areas of acid suppression, improved surgical tech niques and most recently laparoscopic fundoplication. This chapter reviews these advances in the paediatric area especially with regard to pathophysio logy, diagnostic testing and therapeutic intervention.