2025, Vol. 7, Issue 1, Part F

Gastroesophageal Reflux (GER) is a frequent physiological phenomenon in infants, children, and adolescents, characterized by the passage of gastric contents into the esophagus. While most cases are benign and self-limiting, a subset of patients develops gastroesophageal reflux disease (GERD), which is associated with troublesome symptoms or complications such as esophagitis, failure to thrive, respiratory manifestations, feeding difficulties, and developmental delays. The clinical presentation varies significantly across age groups, necessitating an individualized approach to diagnosis and management. Diagnosis often relies on clinical evaluation, although objective investigations such as pH monitoring, multichannel intraluminal impedance-pH (MII-pH), upper gastrointestinal series, and endoscopy may be required in atypical or severe presentations.

Management approaches for GER/GERD in children include lifestyle modifications, non-pharmacological approaches, pharmacological therapies, and surgical options. Lifestyle modifications such as upright positioning following feeds, thickened feeds, and dietary changes are generally recommended as first-line treatments. Pharmacological treatment typically involves acid suppression using either proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs), although concerns over safety with continuing treatment long-term has led to a re-evaluation of the use of these medications especially in infants. Prokinetics and alginates may also be available therapeutic options in specific patients. Surgery can be used in patients with medically refractory GERD or complications from GERD that are life threatening including laparoscopic Nissen fundoplication or magnetic sphincter augmentation.