Diagnosis and treatment of gastroesophageal reflux in infants and children.
Most infants with pathologic GER will respond to medical treatment when the condition is recognized. For this reason a more aggressive approach should be instituted in the evaluation of patients with symptoms in order to prevent the serious complications of severe peptic esophagitis with ulceration and bleeding, stricture, failure to thrive, and life-threatening pulmonary complications, which in most instances will require an antireflux operation. Fortunately, experience with the Nissen fundoplication has been associated with low morbidity and no mortality. Despite the accuracy of 3-hour continuous intraesophageal pH monitoring in establishing the diagnosis of pathologic GER, esophageal manometry and esophagogram are an important adjunct in assessing esophageal motility and LES competence as well as establishing the presence of stricture or gastric dysmotility. This is especially critical in the patient with life-threatening acute and chronic pulmonary complications, in whom there is a distinct need to establish accurately the correlation of pulmonary symptoms with reflux. In some instances, endoscopic procedures on the esophagus and tracheobronchial tree may even be necessary.
D000367:Age Factors; D002648:Child; D004724:Endoscopy; D004941:Esophagitis / Q000209:etiology; D004943:Esophagogastric Junction / Q000601:surgery*; D004947:Esophagus / Q000000981:diagnostic imaging; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007231:Infant, Newborn; D008365:Manometry; D011183:Postoperative Complications / Q000601:surgery; D011859:Radiography