Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: Recommendations of the North American Society for Pediatric Gastroenterology and Nutrition

Gastroesophageal reflux (GER), defined as passage of gastric contents into the esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common pediatric problems encountered by both primary and spec ialty medical providers. Clinical manifestations of GERD in children includ e vomiting, poor weight gain, dysphagia, abdominal or substernal pain, esop hagitis and respiratory disorders. The GER Guideline Committee of the North American Society for Pediatric Gastroenterology and Nutrition has formulat ed a clinical practice guideline for the management of pediatric GER. The G ER Guideline Committee, consisting of a primary care pediatrician, two clin ical epidemiologists (who also practice primary care pediatrics) and five p ediatric gastroenterologists, based its recommendations on an integration o f a comprehensive and systematic review of the medical literature combined with expert opinion. Consensus was achieved through Nominal Group Technique , a structured quantitative method. The Committee examined the value of diagnostic tests and treatment modaliti es commonly used for the management of GERD, and how those interventions ca n be applied to clinical situations in the infant and older child. The guid eline provides recommendations for management by the primary care provider, including evaluation, initial treatment, follow-up management and indicati ons for consultation by a specialist. The guideline also provides recommend ations for management by the pediatric gastroenterologist. This document represents the official recommendations of the North American Society for Pediatric Gastroenterology and Nutrition on the evaluation and treatment of gastroesophageal reflux in infants and children. The American Academy of Pediatrics has also endorsed these recommendations. The recomme ndations are summarized in a synopsis within the article. This review and r ecommendations are a general guideline and are not intended as a substitute for clinical judgment or as a protocol for the management of all patients with this problem.