Management of gastro-oesophageal reflux disease in childhood

Gastro-oesophageal reflux disease (GORD) is common in children. The clinical presentation varies for different paediatric age groups. Minor gastro-oesophageal reflux is considered physiological in infancy but requires treatment if reflux oesophagitis, haematemesis, feeding difficulties, failure to thrive or respiratory manifestations are present. CP, cystic fibrosis and oesophageal atresia are associated with an increased incidence of GORD. In neurologically impaired children, GORD may be severe and cause ulcerative oesophagitis or chronic pulmonary aspiration. The diagnosis of GORD is based on clinical observation, as well as investigations (e.g. barium meal, oesophageal pH monitoring, gastroscopy and nuclear medicine studies). GORD in infancy may be caused by cow’s milk allergy. Eosinophilic oesophagitis, a chronic from of oesophagitis associated with food allergy and atopy, may mimic GORD. Complications of longstanding, untreated GORD include peptic oesophageal strictures, Barrett’s metaplasia and adenocarcinoma. Treatment of GORD relies on dietary interventions, acid suppressive medications and motility agents. In severe cases, a surgical antireflux procedure (fundoplication) may be required. The prognosis of infantile GORD is generally good, and clinical remission usually occurs between 12 and 18 months of age. In older children, GORD is likely to persist to adult life.