pediatrics
Gastroesophageal Reflux in Infants
Introduction
Gastroesophageal reflux is the movement of gastric contents into the esophagus. It may be physiologic or pathologic. When pathologic, it is also known as gastroesophageal reflux disease (GERD). GERD is reflux that causes complications such as irritability, respiratory problems, and poor growth. Diagnosis is often made clinically and could include a trial of dietary change or in some instances a trial of acid-suppressing medication, but some infants require an upper gastrointestinal contrast x-ray series, use of esophageal pH and impedance probes, and sometimes endoscopy. Gastroesophageal reflux requires only reassurance. Treatment of GERD begins with modification of feeding and after-feeding positioning; some infants require acid-suppressing medications such as proton pump inhibitors or H2 blockers. Antireflux surgery is needed only for the most severe cases. Gastroesophageal reflux occurs in almost all infants, manifesting as wet burps after feeding and/or spit-ups (the non-forceful return of milk or gastric contents to the esophagus, pharynx, and mouth). The incidence of gastroesophageal reflux increases between 2 months and 6 months of age (likely due to an increased volume of liquid at each feeding) and then starts to decrease after 7 months. Gastroesophageal reflux resolves in about 85% of infants by 12 months and in 95% by 18 months. Gastroesophageal refluxdisease(GERD), ie, reflux that causes complications, is much less common. 