Diagnosis and treatment of gastro-oesophageal reflux.

Gastro-oesophageal reflux (GOR) is defined as the involuntary passage of gastric contents into the oesophagus, and is a common cause of morbidity in childhood.GOR is an occasional physiological event in normal adults and children,1 2 but becomes pathological when its intensity or frequency increases or when com- plications arise (for example, oesophagitis, fail- ure to thrive).GOR may be primary (due to anatomical or physiological abnormalities) or secondary to other diseases such as urinary tract infection, metabolic disorders, food allergy, etc (see table 1).The increasing avail- ability of lower oesophageal pH monitoring, paediatric endoscopic skills, and newer more effective pharmacological agents has led to a greater awareness of the range of symptoms attributable to gastro-oesophageal reflux disease (GORD), and the need for a structured approach to diagnosis and management.Presenting symptoms Although vomiting is the most common symp- tom of primary GORD, it is now recognised that children and infants may present with a wide variety of other symptoms (see table 2).These may be related to oesophagitis, for example, haematemesis, anaemia, chest pain, or general irritability or from respiratory com- plications such as recurrent aspiration pneumonia, apnoea, or stridor.GOR may also be a factor in the aetiology of apparent life threaten- ing events.Certain seizure-like events or dystonic posturing (Sandifer-Sutcliffe syndrome) may result from GORD.3 Clinical assessment The history must establish the nature and fre- Table 1 Causes of secondary reflux * Infective Gastroenteritis, urinary tract infection * Intestinal obstruction