Gastroesophageal reflux disease

Abstract

Gastroesophageal reflux (GER), caused by the transient relaxation of the lower esophageal sphincter (LES), is the term used to describe the backflow of gastric contents into the esophagus. Pathological reflux disease is a situation in which reflux causes symptoms and complications, such as failure to thrive, disturbances of sleep, recurrent aspiration and cough, predominantly in young infants, and epigastric pain, esophagitis, stenosis, or Barrett's esophagus in older children. Pathological reflux is common after congenital malformations, such as esophageal atresia, diaphragmatic hernia, congenital hiatal hernia and upside-down stomach, and others. A variety of diagnostic investigations, such as esophagogram, manometry, pH monitoring, impedance monitoring, and endoscopy with biopsy, are needed to evaluate the extent and consequences of pathological reflux. Conservative management, with or without medications, is widely used. However, in children with chronic gastroesophageal disease, surgical therapy by fundoplication is the treatment of choice.