Gastroesophageal Reflux

Gastro-esophageal reflux (GER) is common in infants and children. The European and North American Societies for Pediatric Gastroenterology, Hepatology, and Nutrition have developed guidelines for the diagnosis and management of infants and children with GER(-disease). In the majority of patients, the diagnosis is made on clinical manifestations. In the absence of symptoms of overt GER such as regurgitation/vomiting and heartburn, a diagnostic workup is recommended. In infants presenting with troublesome regurgitation, parental guidance and reassurance in combination with nutritional and positional treatment should be the first-line approach. Infant distress and crying are not specific for GER disease and should preferably not be empirically treated with acid-suppressive medication. Likewise, in infants, regurgitation/vomiting may be secondary to other conditions but is not indicative of cow's milk allergy in the absence of other symptoms of atopy. Proton pump inhibitors are recommended to treat acid GER disease and can be used empirically in older symptomatic children (>8 years). In children with prolonged or severe symptoms, determination of the underlying etiology enables appropriate therapeutic intervention.