Abstract
It remains a challenge to diagnose and treat gastro-esophageal reflux (GER) and GER disease (GERD) in infants and children. Together with Embase, MEDLINE, and the Cochrane Database, the published guidelines and position papers were reviewed and summarized in order to suggest a realistic GER and GERD strategy and management for healthcare providers and to standardize and enhance the quality of care for infants and children. Two algorithms were developed for this purpose, 1 for infants <12 months of age and the other for older children. None of the signs and symptoms of GER and GERD are unique and there is no screening test or tool for a gold standard. As a first-line approach, nutritional management is recommended in babies, while for early management, a clinical trial with antacid medication is recommended in children. The aim of the realistic recommendations of this review is to optimize GER management in infants and older children and to minimize the number of investigations and the improper use of medication.
 Keywords: Gastro-esophageal reflux, Gastroesophageal reflux disease, Esophagitis, Endoscopy, Impedance, Proton pump inhibitors, pH.
Highlights
Guidelines on gastroesophageal reflux (GER) and GER disease (GERD) were published in 2009 and 2018 by the joint committees of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)[1,2]
GERD is evident in the presence of regurgitation, heartburn, reflux esophagitis, or esophageal stenosis, and is strongly suspected in cases of hematemesis and inability to thrive in children who vomit
When attention was given to the endoscopic presence of the mucosa in control patients, the upper endoscopy negative predictive value (NPV) decreased to only 33%[15]. These results suggest that the presence of GERD does not rule out a biopsy without the hallmarks of esophagitis or the absence of macroscopic lesions
Summary
Guidelines on gastroesophageal reflux (GER) and GER disease (GERD) were published in 2009 and 2018 by the joint committees of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)[1,2]. In infants and children, the range of potential GERD symptoms varies widely by age and is non-specific [1,4]. This can lead to both over- and under-diagnosis and care that is not required. In children with underlying medical disorders, such as esophageal atresia, developmental dysfunction and respiratory issues, including cystic fibrosis, International Journal of Medical and Biomedical Studies (IJMBS)
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