title: Gastroesophageal reflux in the 21st century.
abstract: OBJECTIVE
  Gastroesophageal reflux (GER) remains a common, challenging problem for clinicians, with differentiation of normal development from disease a particular issue. This review updates clinicians on advances in diagnosis of GER, relationship to other problems, and current practice in management.
  
  
  RESULTS
  Development and understanding of multichannel intraluminal impedance-pH monitoring has given insights into the relationship of GER to symptoms. Medical treatment has changed little. Avoidance of overmedicalizing normal development is the major issue for clinicians. Laparoscopic fundoplication is established as equivalent to open fundoplication. Newer endoscopic techniques have only limited use in children to date.
  
  
  CONCLUSIONS
  Major changes in pediatric GER relate to understanding of physiology and relationship of GER to symptoms. The major challenge for clinicians involve differentiation of normal from abnormal GER, and applying the most relevant management.
authors.affiliation: aDepartment of Gastroenterology, Princess Margaret Hospital for Children bSchool of Paediatrics & Child Health, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Forbes
authors.forename: Alicia
authors.initials: A
authors.lastname: Lim
authors.forename: Madhur
authors.initials: M
authors.lastname: Ravikumara
mesh_terms: D002648:Child; D002675:Child, Preschool; D050782:Esophageal pH Monitoring / Q000379:methods*; D018662:Fundoplication / Q000379:methods; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity