A global, evidence-based consensus on the definition of gastroesophageal reflux disease in the pediatric population.
OBJECTIVE
To develop an international consensus on the definition of gastroesophageal reflux disease (GERD) in the pediatric population.


METHODS
Using the Delphi process, a set of statements was developed and voted on by an international panel of eight pediatric gastroenterologists. Statements were based on systematic literature searches using Medline, EMBASE, and CINAHL. Voting was conducted using a six-point scale, with consensus defined, a priori, as agreed by 75% of the group. The strength of each statement was assessed using the GRADE system.


RESULTS
There were four rounds of voting. In the final vote, consensus was reached on 98% of the 59 statements. In this vote, 95% of the statements were accepted by seven of eight voters. Consensus items of particular note were: (i) GERD is present when reflux of gastric contents causes troublesome symptoms and/or complications, but this definition is complicated by unreliable reporting of symptoms in children under the age of approximately 8 years; (ii) histology has limited use in establishing or excluding a diagnosis of GERD; its primary role is to exclude other conditions; (iii) Barrett's esophagus should be defined as esophageal metaplasia that is intestinal metaplasia positive or negative; and (iv) extraesophageal conditions may be associated with GERD, but for most of these conditions causality remains to be established.


CONCLUSIONS
The consensus statements that comprise the Definition of GERD in the Pediatric Population were developed through a rigorous process. These statements are intended to be used for the development of future clinical practice guidelines and as a basis for clinical trials.
Gastroenterology-Pediatric, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. philip.sherman@sickkids.ca
Philip M
PM
Sherman
Eric
E
Hassall
Ulysses
U
Fagundes-Neto
Benjamin D
BD
Gold
Seiichi
S
Kato
Sibylle
S
Koletzko
Susan
S
Orenstein
Colin
C
Rudolph
Nimish
N
Vakil
Yvan
Y
Vandenplas
D000293:Adolescent; D002170:Canada; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D005260:Female; D005762:Gastroenterology / Q000592:standards*; D005764:Gastroesophageal Reflux / Q000145:classification*; D006801:Humans; D007391:International Cooperation; D008297:Male; D010372:Pediatrics; D012680:Sensitivity and Specificity