GASTROESOPHAGEAL REFLUX DISEASE

Abstract

Reflux of stomach contents into distal esophagus is normal in the first few months of life and resolves spontaneously. The same reflux, when persistent and severe, results in acid and pepsin induced damage to esophageal mucosa and pathological effects in the aero-respiratory tract, resulting in “troublesome symptoms”. This is called gastroesophageal reflux disease. While maternal complaints of vomiting, spitting, posseting and regurgitations are very common, the pediatrician should be careful to differentiate between simple reflux and reflux disease to avoid unnecessary medication. They should be familiar with red flag symptoms that warrant investigations, and which investigation to be relied upon for diagnosis of “disease”. Acid suppression, drugs to promote gastric emptying and increase LES pressure are the cornerstones of therapy. Unlike adult GERD, pediatric GERD therapy need not be prolonged and can be stopped once lesions heal in the esophagus. Recurrences are uncommon if lifestyle changes and dietary modifications are followed strictly. Surgery is to be restricted to intractable GERD, usually seen in the context of neurological deficit.