Definition
- Gastroesophageal reflux (GER) is the normal physiologic passage of gastric contents into the esophagus
- GER is categorized as a disease (gastroesophageal reflux disease [GERD]) when reflux is associated with warning signs and/or complications, and requires further evaluation
Epidemiology
- Frequency of physiologic regurgitation decreases as a child reaches the first year of life and eventually resolves by 12-18 months of age
- More common in formula-fed infants than in purely breastfed infants
- Increased incidence in infants 4 months of age
Etiology
- Produced by various mechanisms such as frequent occurrence of transient relaxation of the lower esophageal sphincter (LES), pressure abnormalities in the lower esophageal sphincter
- Other factors in the pathology of gastroesophageal reflux disease include poor esophageal clearance, delayed gastric emptying time and hiatal hernia
- Genetic predisposition have been associated with the diagnosis of gastroesophageal reflux disease
Signs and Symptoms
- Infants <12 months of age:
- Refusal to eat
- Recurrent vomiting
- Poor weight gain
- Irritability
- Sleep disturbance
- Respiratory symptoms (coughing, wheezing, choking)
- Upper airway symptoms (prolonged/chronic cough, hoarseness)
- Children ≥1 year of age and adolescents:
- Abdominal pain/heartburn
- Recurrent vomiting
- Dysphagia
- Asthma
- Recurrent pneumonia
Warning Signs
- Gastrointestinal tract bleeding (hematemesis, hematochezia)
- Abdominal tenderness/distension, palpable abdominal mass
- Bilious vomiting
- Projectile vomiting
- Fever
- Lethargy, irritability
- Hepatosplenomegaly
- Seizures
- Bulging fontanelle
- Positive for genetic/metabolic syndrome
Risk Factors
- Neurological impairment
- Obesity
- History of esophageal atresia repair
- Hiatal hernia
- Achalasia
- Chronic respiratory disease (eg idiopathic interstitial fibrosis, cystic fibrosis, bronchopulmonary dysplasia)
- Lung transplantation
- Preterm infants
- Certain genetic disorders