Materiały źródłowe

• #1 Gastroesophageal Reflux in Infants and Children: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2025/0100/gastroesophageal-reflux-infants-children.html

  Gastroesophageal reflux is a common physiologic event in infants in which gastric contents pass from the stomach into the esophagus. Gastroesophageal reflux may be asymptomatic or cause regurgitation or spit up. This occurs daily in approximately 40% of infants. Symptoms often begin before 8 weeks of life, peak at approximately 4 months of age, and usually resolve by 1 year. The prevalence of gastroesophageal reflux is 2% to 8% in children and adolescents. Family physicians should reassure parents that gastroesophageal reflux is self-limited, not pathologic, and does not warrant routine testing or pharmacologic treatment. […] Gastroesophageal reflux may progress to gastroesophageal reflux disease when the reflux leads to troublesome symptoms (eg, recurrent postprandial expressions of distress or pain, coughing, choking) or causes complications, such as esophageal stricture or reflux esophagitis. Diagnostic tests, such as endoscopy, barium study, multichannel intraluminal impedance, and pH monitoring, may be used when there is diagnostic uncertainty or alarm symptoms are present (eg, bilious or projectile vomiting, hematemesis). […] Infants and children who do not improve with conservative measures may require pharmacologic treatment, including an empiric trial of acid-suppression therapy for 4 to 8 weeks.

• #2 Reflux in babies

  https://www2.hse.ie/conditions/reflux-babies/

  Reflux is sometimes called GOR (Gastro-oesophageal reflux). […] GORD (Gastro-oesophageal reflux disease) means that your baby’s reflux is happening more often and becoming painful for your baby. […] Your GP or PHN will check your baby’s growth and development. They will give you advice on things you can do to help your baby. […] Most babies don’t need any treatment. But a GP may sometimes recommend treatments or tests for reflux. […] If your baby is breastfed, your GP might give you a powder to stop milk and acid from being brought back up into the food pipe. This powder is called alginates. […] If your baby is formula fed or combination fed, your GP or PHN may advise: smaller, more frequent feeds for your baby, while making sure your baby is getting enough formula daily; a pre-thickened formula mix; adding a powder called an alginate to your baby’s feed – this is to stop milk and acid from being brought back up their food pipe.

• #3 Reflux in babies

  https://www.nhs.uk/conditions/reflux-in-babies/

  Reflux usually starts before a baby is 8 weeks old and gets better by the time they’re 1. […] Symptoms of reflux in babies include: bringing up milk or being sick during or shortly after feeding. […] Sometimes babies may have signs of reflux but will not bring up milk or be sick. This is known as silent reflux. […] Your baby does not usually need to see a doctor if they have reflux, as long as they’re happy, healthy and gaining weight. […] Non-urgent advice: See a GP if your baby: is not improving after trying things to ease reflux. […] A GP or specialist may sometimes recommend treatments for reflux. […] If the thickening powder does not help or your baby is breastfed, a GP or specialist might recommend medicines that stop your baby’s stomach producing as much acid. […] Very rarely, surgery might be needed to strengthen the muscles to stop food or milk travelling back up. This is usually only after trying other things or if their reflux is severe. […] Reflux usually happens because your baby’s food pipe (oesophagus) has not fully developed, so milk can come back up easily.

• #4 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Gastroesophageal reflux is defined as the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting. […] The diagnoses of gastroesophageal reflux and GERD are based on the history and physical examination. […] Diagnostic tests, such as endoscopy, barium study, multiple intraluminal impedance, and pH monitoring, are reserved for when there are atypical symptoms, warning signs, doubts about the diagnosis, or suspected complications or treatment failure. […] The diagnosis of gastroesophageal reflux and GERD should be based primarily on history and physical examination findings because other diagnostic tests have not shown superior accuracy. […] The diagnosis of GERD is usually based on parent- or adolescent-reported symptoms that are attributable to gastroesophageal reflux and are troublesome to the patient.

• #5 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Gastroesophageal reflux is defined as the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting. […] The diagnoses of gastroesophageal reflux and GERD are based on the history and physical examination. […] Diagnostic tests, such as endoscopy, barium study, multiple intraluminal impedance, and pH monitoring, are reserved for when there are atypical symptoms, warning signs, doubts about the diagnosis, or suspected complications or treatment failure. […] The diagnosis of gastroesophageal reflux and GERD should be based primarily on history and physical examination findings because other diagnostic tests have not shown superior accuracy. […] The diagnosis of GERD is usually based on parent- or adolescent-reported symptoms that are attributable to gastroesophageal reflux and are troublesome to the patient.

• #6 Infant GORD and reflux: Diagnosis and management – Medical Independent

  https://www.medicalindependent.ie/nursing-in-practice-ireland/nipi-cpd-modules/infant-gord-and-refluxdiagnosis-and-management/

  Gastro-oesophageal reflux (GOR, reflux) is a normal physiological process in infants, but when it becomes symptomatic and causes complications, it is called gastro-oesophageal reflux disease (GORD). […] Confirming whether the condition is reflux or GORD poses a challenge due to the absence of a simple, accurate, and reliable diagnostic test. It is therefore difficult to identify infants who have GORD, and to estimate the real prevalence and burden of the condition. […] In most cases, diagnostic studies are not necessary to diagnose reflux and GORD in infants. The diagnosis is primarily clinical. A thorough clinical history and a complete physical examination remain the cornerstone of diagnosis. When the diagnosis is ambiguous or when complications are suspected, further investigations may be warranted. […] Investigations for GORD such as barium contrast radiography, pH probe, and endoscopy are rarely necessary, and should only be considered on an individual basis after the infant has been assessed by a paediatrician.

• #7 Patient education: Acid reflux (gastroesophageal reflux) in babies (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-in-babies-beyond-the-basics/print

  Gastroesophageal reflux (GER) is the medical term for spitting up. It occurs when the stomach contents reflux or back up into the esophagus and/or mouth. […] In contrast, in a few babies, GER causes complications. In this case, the condition is known as gastroesophageal reflux disease, or „GERD.” Babies with proven GERD may require treatment. […] Testing is not usually necessary for babies with uncomplicated reflux. They should be evaluated if the symptoms worsen, appear for the first time after six months of age, or do not improve by the time they are 18 to 24 months of age. […] If a health care provider evaluates your baby for reflux, they will first review the baby’s symptoms and medical history and do a physical examination. If this evaluation suggests that the baby has typical (uncomplicated) reflux, then they might just follow the symptoms during regular check-ups.

• #8 Reflux in Babies: Signs & Treatment

  https://my.clevelandclinic.org/health/diseases/reflux-in-babies

  Reflux is when food from your babys stomach returns to their esophagus, which may lead to spitting up or vomiting. […] But its sometimes a sign of gastroesophageal reflux disease (GERD) or other conditions that need medical treatment. […] If your baby spits up a lot and youre worried, its worth having a conversation with your pediatrician. […] Theyll consider your babys symptoms and medical history to diagnose or rule out GERD and other possible medical conditions. […] Your pediatrician will review your babys medical history and do a physical exam. […] They need to find out if your babys reflux is something theyll outgrow (GER) or a disease that may need treatment (GERD). […] If they suspect GERD, theyll look for signs of complications. […] Most babies dont need diagnostic testing.

• #9 Reflux in Infants: MedlinePlus

  https://medlineplus.gov/refluxininfants.html

  In most cases, a doctor diagnoses reflux by reviewing your baby’s symptoms and medical history. […] Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Common tests include: […] Upper GI series, which looks at the shape of your baby’s upper GI (gastrointestinal) tract. […] Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your baby’s esophagus. […] Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it.

• #10 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Diagnostic testing is generally not necessary because it has not been found to be more reliable than the history and physical examination for diagnosing gastroesophageal reflux or GERD. […] Upper endoscopy with biopsy is considered when reflux does not respond to initial treatments. It is the principal method of evaluating the esophageal mucosa for complications of GERD and excluding other possible causes, such as eosinophilic esophagitis, esophageal webs, and infectious esophagitis. […] If symptoms do not improve with acid suppression therapy, diagnostic testing is warranted to evaluate treatment failure, identify complications of GERD, establish a relationship between atypical symptoms and reflux, and exclude other diagnoses.

• #11 Infant reflux | Better Health Channel

  https://www.betterhealth.vic.gov.au/conditions-and-treatments/infant-reflux

  Reflux is common in babies and causes no pain or problems with weight gain in most babies. […] Reflux medications do not improve crying in most babies. […] In some cases, medications may help if your baby has a medical condition known as gastro-oesophageal reflux disease (GORD). […] Reflux or gastro-oesophageal reflux (GOR) is when food (or milk) from the stomach comes back up the oesophagus (food tube), or into the mouth. […] In most babies, reflux causes no pain or problems with weight gain. […] Although it seems logical that reflux might cause babies to cry, studies show that reflux medications do not improve crying in most babies. […] Gastro-oesphageal reflux disease (GORD) is different to reflux. GORD is a medical condition that needs to be diagnosed by a doctor and affects small numbers of babies who have frequent vomiting AND other symptoms like choking, coughing or wheezing during feeds, vomiting up blood, distress during feeds or refusal to feed, poor weight gain or weight loss.

• #12 Gastroesophageal Reflux: Symptoms, Diagnosis and Treatment | Nationwide Children’s Hospital

  https://www.nationwidechildrens.org/conditions/gastroesophageal-reflux

  Gastroesophageal reflux can cause heartburn (esophagitis, inflammation of the esophagus) which may make the baby fussy. […] Diagnosis of gastroesophageal reflux is made by taking a medical history and physical exam. Testing is not usually needed. […] Some of the following tests may be done if your child doesn’t respond to treatment or if your doctor or nurse practitioner is concerned that something else may be going on. […] Most babies with gastroesophageal reflux do not require treatment and will outgrow the reflux. […] If your child is having one of the following complications, your doctor or nurse practitioner may consider treatment for your infant. […] Therapy is designed to treat the complication and usually does not stop the infant from spitting up. […] Most children do not need surgery for their reflux since there is a very good chance that they will outgrow it. […] Your baby’s treatment will be designed to help relieve the symptom that was causing them the most problems (irritability, poor growth, or breathing problems).

• #13 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Gastroesophageal reflux is defined as the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting. […] The diagnoses of gastroesophageal reflux and GERD are based on the history and physical examination. […] Diagnostic tests, such as endoscopy, barium study, multiple intraluminal impedance, and pH monitoring, are reserved for when there are atypical symptoms, warning signs, doubts about the diagnosis, or suspected complications or treatment failure. […] The diagnosis of gastroesophageal reflux and GERD should be based primarily on history and physical examination findings because other diagnostic tests have not shown superior accuracy. […] The diagnosis of GERD is usually based on parent- or adolescent-reported symptoms that are attributable to gastroesophageal reflux and are troublesome to the patient.

• #14 Gastroesophageal Reflux in Infants – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/gastrointestinal-disorders-in-neonates-and-infants/gastroesophageal-reflux-in-infants

  Gastroesophageal reflux is the movement of gastric contents into the esophagus. […] Diagnosis is often made clinically and could include a trial of dietary change or in some instances a trial of acid-suppressing medication, but some infants require an upper gastrointestinal contrast x-ray series, use of esophageal pH and impedance probes, and sometimes endoscopy. […] Diagnosis of Reflux in Infants includes clinical evaluation, typically upper gastrointestinal (GI) series, and sometimes esophageal pH measurement or endoscopy. […] Infants who have symptoms consistent with GERD but no severe complications may be given a therapeutic trial of acid-reducing medication for GERD. […] If the diagnosis remains unclear or there is still a question of whether reflux is actually the cause of symptoms such as coughing or wheezing, a pediatric gastroenterologist may do tests using esophageal pH or impedance probes.

• #15 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  To diagnose infant reflux, a healthcare professional typically starts with a physical exam and asks questions about a baby’s symptoms. If a baby is growing as expected and seems content, then testing usually isn’t needed. In some cases, however, a healthcare professional might recommend: […] Ultrasound. This imaging test can detect pyloric stenosis. […] Lab tests. Blood and urine tests can help find or rule out possible causes of poor weight gain and vomiting that happens often. […] Esophageal pH monitoring. To measure the acidity in a baby’s esophagus, the health professional places a thin tube through the baby’s nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. A baby might need to stay in the hospital while being monitored. […] X-rays. These images can detect problems in the digestive tract, such as a blockage. A baby may be given a contrast liquid with a bottle before the test. This liquid is usually barium.

• #16 Gastroesophageal Reflux in Children – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/gastrointestinal-disorders-in-children/gastroesophageal-reflux-in-children

  Tests that help doctors diagnose the disorder include a barium study, an esophageal pH probe, a gastric emptying scan, endoscopy, and sometimes ultrasonography. […] Tests are often not needed to diagnose gastroesophageal reflux in infants or older children who simply have mild symptoms such as frequent spit-ups (in infants) and heartburn (in older children). However, if symptoms are more complicated, various tests can be done. […] A barium study is the most common test. The child swallows barium, a liquid that outlines the digestive tract when x-rays are taken. Although this test can help the doctor diagnose gastroesophageal reflux, it more importantly helps the doctor identify some of the possible causes of the reflux. […] An esophageal pH probe is a thin flexible tube with a sensor at the tip that measures the degree of acidity (pH). Doctors pass the tube through the child’s nose, down the throat, and into the end of the esophagus. The tube is usually left in place for 24 hours. Normally, children do not have acid in their esophagus, so if the sensor detects acid, it is a sign of reflux.

• #17 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  To diagnose infant reflux, a healthcare professional typically starts with a physical exam and asks questions about a baby’s symptoms. If a baby is growing as expected and seems content, then testing usually isn’t needed. In some cases, however, a healthcare professional might recommend: […] Ultrasound. This imaging test can detect pyloric stenosis. […] Lab tests. Blood and urine tests can help find or rule out possible causes of poor weight gain and vomiting that happens often. […] Esophageal pH monitoring. To measure the acidity in a baby’s esophagus, the health professional places a thin tube through the baby’s nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. A baby might need to stay in the hospital while being monitored. […] X-rays. These images can detect problems in the digestive tract, such as a blockage. A baby may be given a contrast liquid with a bottle before the test. This liquid is usually barium.

• #18 Childhood gastroesophageal reflux disease: A comprehensive review of disease, diagnosis, and therapeutic management

  https://www.wjgnet.com/2219-2808/full/v14/i2/101175.htm

  This evaluation may include an upper GI barium study, ultrasound, esophageal manometry, a trial of proton pump inhibitors (PPIs), scintigraphy, esophagogastroduodenoscopy, esophageal pH monitoring, and multichannel intraluminal impedance (MII). […] Esophageal pH monitoring is a reliable and sensitive method for diagnosing GERD. […] A normal upper GI endoscopy does not rule out GERD, as its negative predictive value is low. […] Barium swallow and upper GI studies are used to evaluate anatomical abnormalities, such as tracheoesophageal fistula, achalasia, and hiatus hernia. […] Ultrasound has a high sensitivity and positive predictive value for GERD as it can evaluate both the esophagus’s anatomy and real-time reflux. […] Diagnosing GERD in children requires a nuanced approach due to the diverse range of symptoms and the challenges associated with diagnosis in younger patients. Effective management hinges on a thorough clinical assessment, supported by appropriate diagnostic tools like MII-pH monitoring and endoscopy, to accurately identify and evaluate the condition.

• #19 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  Upper endoscopy. An upper endoscopy uses a tiny camera on the end of a flexible tube called an endoscope to visually examine the upper digestive system. Tissue samples may be taken for analysis. For infants and children, endoscopy usually is done under general anesthesia. General anesthesia causes a sleeplike state before surgery or other medical procedures.

• #20 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Diagnostic testing is generally not necessary because it has not been found to be more reliable than the history and physical examination for diagnosing gastroesophageal reflux or GERD. […] Upper endoscopy with biopsy is considered when reflux does not respond to initial treatments. It is the principal method of evaluating the esophageal mucosa for complications of GERD and excluding other possible causes, such as eosinophilic esophagitis, esophageal webs, and infectious esophagitis. […] If symptoms do not improve with acid suppression therapy, diagnostic testing is warranted to evaluate treatment failure, identify complications of GERD, establish a relationship between atypical symptoms and reflux, and exclude other diagnoses.

• #21 Patient education: Acid reflux (gastroesophageal reflux) in babies (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-in-babies-beyond-the-basics/print

  In some cases, the health care provider might arrange for tests, such as laboratory testing (blood and/or urine tests), an X-ray study to evaluate how well the baby swallows and to evaluate the anatomy of the stomach, a procedure called upper endoscopy to view and sample (biopsy) the lining of the esophagus, or a neurologic evaluation (for babies with extreme irritability that is not explained). […] If your baby has concerning symptoms that might be related to acid reflux, such as severe irritability, feeding refusal, or poor weight gain, talk to their health care provider.

• #22 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  To diagnose infant reflux, a healthcare professional typically starts with a physical exam and asks questions about a baby’s symptoms. If a baby is growing as expected and seems content, then testing usually isn’t needed. In some cases, however, a healthcare professional might recommend: […] Ultrasound. This imaging test can detect pyloric stenosis. […] Lab tests. Blood and urine tests can help find or rule out possible causes of poor weight gain and vomiting that happens often. […] Esophageal pH monitoring. To measure the acidity in a baby’s esophagus, the health professional places a thin tube through the baby’s nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. A baby might need to stay in the hospital while being monitored. […] X-rays. These images can detect problems in the digestive tract, such as a blockage. A baby may be given a contrast liquid with a bottle before the test. This liquid is usually barium.

• #23 Pediatric Gastroesophageal Reflux Workup: Approach Considerations, Imaging Studies, Intraesophageal pH Probe Monitoring

  https://emedicine.medscape.com/article/930029-workup

  In most cases of gastroesophageal reflux, the diagnosis can be made from the history and physical examination. Conservative measures can be started empirically. However, if the presentation is atypical or if the response to therapy is minimal, further evaluation via imaging is warranted. […] This modality is useful in patients who are unresponsive to medical therapy. It allows for visualization of the mucosa for diagnosis of peptic ulcer disease, Helicobacter pylori infection, strictures, and peptic esophagitis. It also provides access to obtain biopsies for histopathologic examination. […] Although pH monitoring has become a widely overused modality, it remains the criterion standard for quantifying gastroesophageal reflux. […] Esophageal pH monitoring is not indicated in cases of obvious gastroesophageal reflux but is useful in demonstrating an association between reflux and symptoms in atypical presentations and in grading the risk of esophagitis. […] Intraluminal esophageal electrical impedance (EEI) is useful for detecting both acid reflux and nonacid reflux by measuring retrograde flow in the esophagus.

• #24 Reflux in Infants: MedlinePlus

  https://medlineplus.gov/refluxininfants.html

  In most cases, a doctor diagnoses reflux by reviewing your baby’s symptoms and medical history. […] Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Common tests include: […] Upper GI series, which looks at the shape of your baby’s upper GI (gastrointestinal) tract. […] Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your baby’s esophagus. […] Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it.

• #25 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2019.22.2.107

  The sensitivity of erosive esophagitis in diagnosing GERD was reported to range from 15% up to 71% and the sensitivity of microscopic esophagitis in diagnosing GERD was between 83% and 88%. […] These findings indicate that a biopsy without the hallmarks of esophagitis or the absence of macroscopic lesions does not rule out the presence of GERD. […] There is insufficient evidence to support the use of endoscopy with or without biopsy for the diagnosis of GERD in infants and children. […] The indications to perform pH-MII are: 1) to measure the efficacy of acid suppression medication; 2) to differentiate NERD, hypersensitive esophagus, and functional heartburn in patients with normal endoscopies and histology; 3) to correlate persistent troublesome symptoms with acid and non-acid GER events; and 4) to establish the role of acid and non-acid reflux in the etiology of esophagitis and other signs and symptoms suggestive of GERD. […] In the absence of alarm symptoms, diagnostic investigations are not recommended at the primary healthcare level.

• #26 Gastroesophageal Reflux in Children – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/gastrointestinal-disorders-in-children/gastroesophageal-reflux-in-children

  An impedance probe is very similar to the esophageal pH probe but it can detect both acid and nonacid reflux. […] A gastric emptying scan is done to determine how quickly the stomach empties. […] In upper endoscopy, the child is sedated, and a small flexible tube with a camera on the end (endoscope) is passed through the mouth into the esophagus and stomach. […] An ultrasound of the abdomen may be done for infants who forcefully vomit, especially those who have lost weight and have complications of dehydration.

• #27 Acid Reflux (GERD) in Babies and Children

  https://www.webmd.com/parenting/baby/infants-children

  Upper GI endoscopy. This is done using an endoscope (a thin, flexible, lighted tube and camera) that allows the doctor to look directly inside the esophagus, stomach, and upper part of the small intestine. […] Gastric emptying study. Some people with GERD have a slow emptying of the stomach which may be contributing to the reflux of acid. During this test, your child drinks milk or eats food mixed with a radioactive chemical. This chemical is followed through the gastrointestinal tract using a special camera.

• #28 Gastroesophageal Reflux in Children – Stanford Medicine Children’s Health

  https://deprod.stanfordchildrens.org/en/topic/default?id=gastroesophageal-reflux-in-children-90-P02364

  In this test, a small, flexible tube (endoscope) is used to look at the inside of your child’s digestive tract. […] This test measures the level of acidity in your child’s esophagus. […] This test will show if your child’s stomach contents empty into their small intestine the correct way. Delayed gastric emptying can cause reflux. […] Call your child’s healthcare provider if your child vomits after every feeding or has new reflux symptoms. […] Reflux is caused by problems with the lower esophageal sphincter. This muscle should open to let food into the stomach and close to keep food in the stomach. When it relaxes too often or for too long, acid goes back into the esophagus. This causes reflux. […] Most babies with reflux have no symptoms other than spitting up often. As long as your baby is growing well and has no other reflux symptoms, he or she won’t need treatment.

• #29 Infant acid reflux – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/diagnosis-treatment/drc-20351412

  To diagnose infant reflux, a healthcare professional typically starts with a physical exam and asks questions about a baby’s symptoms. If a baby is growing as expected and seems content, then testing usually isn’t needed. In some cases, however, a healthcare professional might recommend: […] Ultrasound. This imaging test can detect pyloric stenosis. […] Lab tests. Blood and urine tests can help find or rule out possible causes of poor weight gain and vomiting that happens often. […] Esophageal pH monitoring. To measure the acidity in a baby’s esophagus, the health professional places a thin tube through the baby’s nose or mouth and into the esophagus. The tube is attached to a device that monitors acidity. A baby might need to stay in the hospital while being monitored. […] X-rays. These images can detect problems in the digestive tract, such as a blockage. A baby may be given a contrast liquid with a bottle before the test. This liquid is usually barium.

• #30 Pediatric Gastroesophageal Reflux Differential Diagnoses

  https://emedicine.medscape.com/article/930029-differential

  Vomiting is a symptom associated with many disorders. Accordingly, gastroesophageal reflux cannot be assumed to be the primary problem in infants and children who present with a history of emesis. Warning signals that herald the requirement for additional evaluation include the following: […] The occurrence of any of these signs and symptoms indicates the need to consider a comprehensive metabolic, neurologic, and/or surgical evaluation, in addition to a gastroenterologic workup. […] Conditions to consider in the differential diagnosis of gastroesophageal reflux include the following:

• #31 Episodic apnea: gastroesophageal reflux associated with gastric organo-axial malrotation: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-022-03367-x

  Gastroesophageal reflux is a normal physiologic process occurring several times a day in healthy infants. […] Symptoms such as failure to thrive, feeding or sleeping problems, chronic respiratory distress, persistent forceful vomiting, and choking may indicate reflux associated with underlying anatomic, neurological, or infectious abnormalities. […] Gastric malrotation is one of the anatomic causes associated with severe reflux, which could lead to serious complications. […] Life-threatening symptoms in an infant with reflux suggest anatomic, neurological, or infectious conditions. […] Gastric malrotation is more common than generally thought and specifically looked for in young children with severe reflux symptoms, and should be diagnosed and treated as soon as possible. […] Infants with gastric malrotation have been thought to be at risk for reflux because they usually have a defective gastroesophageal junction during fetal development.

• #32 Infant GORD and reflux: Diagnosis and management – Medical Independent

  https://www.medicalindependent.ie/nursing-in-practice-ireland/nipi-cpd-modules/infant-gord-and-refluxdiagnosis-and-management/

  Diagnosis should be reconsidered if any of the following red flag signs and symptoms are present: […] Infants should be referred to a specialist when regurgitation becomes persistently projectile; there is bile-stained vomiting or haematemesis; there are new concerns such as signs of marked distress, feeding difficulties or poor weight gain; and there is persistent, frequent regurgitation beyond the first year of life. […] Current recommendations do not support an empiric trial of proton pump inhibitors (PPIs) as a diagnostic test for GORD in infants and young children because symptoms suggestive of GORD are not/less specific in children of this age group. […]

• #33 Reflux in babies | Information for the public | Gastro-oesophageal reflux disease in children and young people: diagnosis and management | Guidance | NICE

  https://www.nice.org.uk/guidance/ng1/ifp/chapter/reflux-in-babies

  Some reflux regurgitating or vomiting of feeds is normal in babies. It usually gets better on its own, and does not often need any tests or treatment. […] If you see a healthcare professional about your baby’s regurgitation or vomiting, they will talk with you about your baby, their symptoms and their general health, and they may examine your baby. This is to make sure your child is well, and to check that there is nothing else that could be causing the problem. It will also help the healthcare professional decide whether any tests or treatments are needed or whether the problem will get better on its own. […] If the healthcare professional thinks that there may be something else causing the vomiting or regurgitation, they may find it helpful to do tests, or they may refer your baby to a specialist. […] If your baby has any of the following problems, you should go back to see the healthcare professional: If the regurgitation becomes more forceful. This is also known as 'projectile vomiting’, and is when the vomit is expelled with such force that it lands some distance away.

• #34 Patient education: Acid reflux (gastroesophageal reflux) in babies (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-in-babies-beyond-the-basics

  Gastroesophageal reflux (GER) is the medical term for spitting up. It occurs when the stomach contents reflux or back up into the esophagus and/or mouth. Because the stomach naturally produces acid, reflux is sometimes called „acid reflux”; other terms include „regurgitation” and „spilling.” […] In contrast, in a few babies, GER causes complications. In this case, the condition is known as gastroesophageal reflux disease, or „GERD.” Babies with proven GERD may require treatment. […] Testing is not usually necessary for babies with uncomplicated reflux. They should be evaluated if the symptoms worsen, appear for the first time after six months of age, or do not improve by the time they are 18 to 24 months of age. […] Possible gastroesophageal reflux disease — In a few babies, reflux causes complications, such as irritation or damage to the esophagus, asthma, or recurrent pneumonia. In these cases, the condition is called gastroesophageal reflux disease, or „GERD.” This only occurs in a small percentage of babies who spit up frequently.

• #35 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2019.22.2.107

  The diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) in infants and children remains a challenge. […] None of the signs and symptoms of GER and GERD are specific and there is no gold standard diagnostic test or tool. […] Clinical history and physical examination are important to identify alarm symptoms and signs and differentiate GERD from other disorders. […] The absence of a gold standard diagnostic tool hampers the diagnosis of GERD in infants and children further. […] However, GERD is a prominent phenomenon in children with underlying medical conditions, such as esophageal atresia, neurologic impairment and pulmonary problems, including cystic fibrosis. […] According to the guidelines of the NASPGHAN-ESPGHAN, refractory GERD is GERD which does not or insufficiently responds to optimal treatment after 8 weeks.

• #36 BEFORE YOU GO…

  https://www.thebabyrefluxlady.co.uk/blog/how-baby-reflux-colic-diagnosed

  I regularly get asked how baby reflux is actually diagnosed. The truth is that there are no proper guidelines for diagnosing reflux. […] The difficulty, in truth, and according to the 2018 Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (a.k.a. the medical experts), is that Symptoms of GERD are known to vary widely by age and are non-specific. As a consequence, proving that reflux events cause one or multiple symptoms is often difficult. […] As the medical experts rightly point out, the symptoms in infants with reflux (and this includes all variations you might see of reflux, silent reflux and colic) vary widely.

• #37 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/1015/p705.html

  Gastroesophageal reflux is defined as the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting. […] The diagnoses of gastroesophageal reflux and GERD are based on the history and physical examination. […] Diagnostic tests, such as endoscopy, barium study, multiple intraluminal impedance, and pH monitoring, are reserved for when there are atypical symptoms, warning signs, doubts about the diagnosis, or suspected complications or treatment failure. […] The diagnosis of gastroesophageal reflux and GERD should be based primarily on history and physical examination findings because other diagnostic tests have not shown superior accuracy. […] The diagnosis of GERD is usually based on parent- or adolescent-reported symptoms that are attributable to gastroesophageal reflux and are troublesome to the patient.

• #38 Silent Reflux: Symptoms, Home Remedies, Treatment

  https://www.healthline.com/health/parenting/silent-reflux

  Silent reflux, also called laryngopharyngeal reflux (LPR), is a type of reflux in which stomach contents flow backward into the larynx (the voice box), back of the throat, and nasal passages. […] When the reflux persists beyond a year, or if its causing negative side effects for your child, their pediatrician may recommend treatment. […] Reflux disease is seen in about one in five children. […] In babies and young children, typical signs include: breathing problems, such as wheezing, noisy breathing, or pauses in breathing (apnea); gagging; nasal congestion; chronic coughing; chronic respiratory conditions (such as bronchitis) and ear infections; difficulty breathing (your child may develop asthma); difficulty feeding; spitting up; failure to thrive, which may be diagnosed by a doctor if your baby isnt growing and gaining weight at the expected rate for their age.

• #39 Recognizing Acid Reflux/GERD in Infants: 10 Common Signs

  https://www.healthline.com/health/gerd/recognize-gerd-infants

  Babies can get acid reflux due to underdeveloped esophagus muscles, leading to spitting and vomiting, feeding refusal, difficulty sleeping and growing, and frequent lung infections. […] Infants are more prone to acid reflux because their LES may be weak or underdeveloped. In fact, its estimated that more than half of all infants experience acid reflux to some degree. […] Its rare for an infants symptoms to continue past 24 months. If they persist, it may be a sign of gastroesophageal reflux disease (GERD), which is a more severe condition. […] The doctor can rule out other conditions or confirm a GERD diagnosis.

• #40 Over-diagnosis of reflux in infants leads to needless medication, research finds | ScienceDaily

  https://www.sciencedaily.com/releases/2013/04/130401104403.htm

  Medications used to treat gastroesophageal reflux disease, or GERD, are some of the most widely used medications in children less than one year old. […] Physicians often label common symptoms in infants, such as crying and spitting up, as disease. […] Frequent use of the GERD label can lead to overuse of medication. […] The study found that doctors’ use of the label GERD prompted parents to request medication for their baby even when they had been advised that the medication would probably be ineffective. […] Over-diagnosis of GERD can make a medical condition out of a normal behavior. […] The discomfort can cause the infant to cry, but it is not necessarily a disease. […] Parents can learn from this study that a disease label can make them want medication for their child, regardless of whether the drugs are effective or not. […] Unnecessary use of medication is costly. […] The long-term side effects of the medication frequently prescribed to children diagnosed with GERD have not been fully studied.

• #41 Diagnosing GERD in Neonates? Be Cautious – Pediatrics Nationwide

  https://pediatricsnationwide.org/2016/10/18/diagnosing-gerd-in-neonates-be-cautious/

  Gastroesophageal reflux disease is likely over-diagnosed in neonates, leading to unnecessary and harmful treatment. […] Approximately 10 percent of infants born preterm in the United States are diagnosed with gastroesophageal reflux disease (GERD). But it’s almost certain that not all of those babies actually have GERD, say neonatologists at Nationwide Children’s Hospital. […] “There is no consensus about how best to make the diagnosis of GERD in neonates,” says Dr. Jadcherla, who is also a professor of Pediatrics at The Ohio State University College of Medicine “Most neonatologists, gastroenterologists and ear, nose and throat specialists make the diagnosis subjectively based on airway and digestive symptoms – breathing disturbances, cough, spit up, irritability, arching and feeding difficulties. It’s true that GERD can cause those symptoms. Many other conditions can cause those symptoms as well, though.”

• #42 Over-diagnosis of reflux in infants leads to needless medication, research finds | ScienceDaily

  https://www.sciencedaily.com/releases/2013/04/130401104403.htm

  Medications used to treat gastroesophageal reflux disease, or GERD, are some of the most widely used medications in children less than one year old. […] Physicians often label common symptoms in infants, such as crying and spitting up, as disease. […] Frequent use of the GERD label can lead to overuse of medication. […] The study found that doctors’ use of the label GERD prompted parents to request medication for their baby even when they had been advised that the medication would probably be ineffective. […] Over-diagnosis of GERD can make a medical condition out of a normal behavior. […] The discomfort can cause the infant to cry, but it is not necessarily a disease. […] Parents can learn from this study that a disease label can make them want medication for their child, regardless of whether the drugs are effective or not. […] Unnecessary use of medication is costly. […] The long-term side effects of the medication frequently prescribed to children diagnosed with GERD have not been fully studied.

• #43 Diagnosing GERD in Neonates? Be Cautious – Pediatrics Nationwide

  https://pediatricsnationwide.org/2016/10/18/diagnosing-gerd-in-neonates-be-cautious/

  Gastroesophageal reflux disease is likely over-diagnosed in neonates, leading to unnecessary and harmful treatment. […] Approximately 10 percent of infants born preterm in the United States are diagnosed with gastroesophageal reflux disease (GERD). But it’s almost certain that not all of those babies actually have GERD, say neonatologists at Nationwide Children’s Hospital. […] “There is no consensus about how best to make the diagnosis of GERD in neonates,” says Dr. Jadcherla, who is also a professor of Pediatrics at The Ohio State University College of Medicine “Most neonatologists, gastroenterologists and ear, nose and throat specialists make the diagnosis subjectively based on airway and digestive symptoms – breathing disturbances, cough, spit up, irritability, arching and feeding difficulties. It’s true that GERD can cause those symptoms. Many other conditions can cause those symptoms as well, though.”

• #44 Infant GORD and reflux: Diagnosis and management – Medical Independent

  https://www.medicalindependent.ie/nursing-in-practice-ireland/nipi-cpd-modules/infant-gord-and-refluxdiagnosis-and-management/

  Gastro-oesophageal reflux (GOR, reflux) is a normal physiological process in infants, but when it becomes symptomatic and causes complications, it is called gastro-oesophageal reflux disease (GORD). […] Confirming whether the condition is reflux or GORD poses a challenge due to the absence of a simple, accurate, and reliable diagnostic test. It is therefore difficult to identify infants who have GORD, and to estimate the real prevalence and burden of the condition. […] In most cases, diagnostic studies are not necessary to diagnose reflux and GORD in infants. The diagnosis is primarily clinical. A thorough clinical history and a complete physical examination remain the cornerstone of diagnosis. When the diagnosis is ambiguous or when complications are suspected, further investigations may be warranted. […] Investigations for GORD such as barium contrast radiography, pH probe, and endoscopy are rarely necessary, and should only be considered on an individual basis after the infant has been assessed by a paediatrician.

• #45 Childhood gastroesophageal reflux disease: A comprehensive review of disease, diagnosis, and therapeutic management

  https://www.wjgnet.com/2219-2808/full/v14/i2/101175.htm

  Gastroesophageal reflux disease (GERD) affects both adults and children, although the symptoms differ significantly between these groups. […] Diagnosing GERD in children necessitates a multifaceted approach due to the diverse symptomatology and challenges in communication. Clinical assessment serves as the cornerstone of diagnosis, supported by tools like pH monitoring, esophageal impedance testing, and upper gastrointestinal endoscopy. […] Diagnosing GERD in children continues to be challenging. While diagnostic studies and imaging can assist in excluding other conditions, there is no definitive method for diagnosing pediatric GERD. […] If GERD is suspected, lifestyle changes should be considered, such as thickened feedings, dietary modifications, postural adjustments, weight loss, and avoiding secondhand smoke, overfeeding, and eating before bedtime.

• #46 Diagnosing GERD in Neonates? Be Cautious – Pediatrics Nationwide

  https://pediatricsnationwide.org/2016/10/18/diagnosing-gerd-in-neonates-be-cautious/

  Large-scale, well-controlled, long-term trials are needed to define true guidelines for diagnosing GERD, to learn how prevalent it is and to test multimodal therapies. For now, Dr. Jadcherla recommends 24-hour pH impedance and manometry studies, combined with observed symptoms, before making a diagnosis. […] “Neonatologists should be cautious about diagnosing GERD without objective tests,” he says. “Even if diagnosis and a decision to treat are made, the treatment should be a defined, short course based on improvement of symptoms.”

• #47

  https://link.springer.com/article/10.1007/s11894-010-0140-1

  Answering a need for a thoroughly validated infant gastroesophageal reflux questionnaire, the Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) was designed, refined, and validated using state-of-the-art psychometric methods. Diagnostic and evaluative (tracking) validity was identified. […] The I-GERQ-R is thus adequately sensitive to be used diagnostically to screen infants for symptom burden, but should probably be supplemented by other, perhaps invasive, testing to assure appropriate specificity. The I-GERQ-R’s validation for evaluative properties, however, supports its use for tracking symptoms within clinical trials.

• #48 Infant GORD and reflux: Diagnosis and management – Medical Independent

  https://www.medicalindependent.ie/nursing-in-practice-ireland/nipi-cpd-modules/infant-gord-and-refluxdiagnosis-and-management/

  Diagnosis should be reconsidered if any of the following red flag signs and symptoms are present: […] Infants should be referred to a specialist when regurgitation becomes persistently projectile; there is bile-stained vomiting or haematemesis; there are new concerns such as signs of marked distress, feeding difficulties or poor weight gain; and there is persistent, frequent regurgitation beyond the first year of life. […] Current recommendations do not support an empiric trial of proton pump inhibitors (PPIs) as a diagnostic test for GORD in infants and young children because symptoms suggestive of GORD are not/less specific in children of this age group. […]

• #49 Reflux in babies

  https://www.nhs.uk/conditions/reflux-in-babies/

  Reflux usually starts before a baby is 8 weeks old and gets better by the time they’re 1. […] Symptoms of reflux in babies include: bringing up milk or being sick during or shortly after feeding. […] Sometimes babies may have signs of reflux but will not bring up milk or be sick. This is known as silent reflux. […] Your baby does not usually need to see a doctor if they have reflux, as long as they’re happy, healthy and gaining weight. […] Non-urgent advice: See a GP if your baby: is not improving after trying things to ease reflux. […] A GP or specialist may sometimes recommend treatments for reflux. […] If the thickening powder does not help or your baby is breastfed, a GP or specialist might recommend medicines that stop your baby’s stomach producing as much acid. […] Very rarely, surgery might be needed to strengthen the muscles to stop food or milk travelling back up. This is usually only after trying other things or if their reflux is severe. […] Reflux usually happens because your baby’s food pipe (oesophagus) has not fully developed, so milk can come back up easily.

• #50 Early Diagnosis of Infant Reflux May Prevent Asthma | NYU Langone News

  https://nyulangone.org/news/early-diagnosis-infant-reflux-may-prevent-asthma

  Early Diagnosis of Infant Reflux May Prevent Asthma Melodi B. Pirzada, MD […] Dr. Melodi B. Pirzada studied the relationship between acid reflux and asthma in infants, finding that early diagnosis of acid reflux may prevent long-term pulmonary complications. […] Dr. Pirzada, together with Farah Deshmukh, MD, and Endy A. Dominguez Silveyra, MD, began to analyze the topic in more depth. We hypothesized that young patients were being overdiagnosed with asthma when they might actually just be suffering from reflux, Dr. Pirzada explains. […] If a child has reflux, it doesnt mean they will go on to have asthma, says Dr. Pirzada, But if a child has reflux and eczema, our findings point to that infant being more prone to early-onset asthma. […] Whats most important to consider, is that GERD should be diagnosed and managed as early as possible to prevent potential long-term pulmonary complications, says Dr. Pirzada. Our promising research may lead us to better diagnose the risks of asthma in many young patients, allowing us to take precautions to avoid triggering that chronic condition that can last a lifetime.

• #51 Early Diagnosis of Infant Reflux May Prevent Asthma | NYU Langone News

  https://nyulangone.org/news/early-diagnosis-infant-reflux-may-prevent-asthma

  Early Diagnosis of Infant Reflux May Prevent Asthma Melodi B. Pirzada, MD […] Dr. Melodi B. Pirzada studied the relationship between acid reflux and asthma in infants, finding that early diagnosis of acid reflux may prevent long-term pulmonary complications. […] Dr. Pirzada, together with Farah Deshmukh, MD, and Endy A. Dominguez Silveyra, MD, began to analyze the topic in more depth. We hypothesized that young patients were being overdiagnosed with asthma when they might actually just be suffering from reflux, Dr. Pirzada explains. […] If a child has reflux, it doesnt mean they will go on to have asthma, says Dr. Pirzada, But if a child has reflux and eczema, our findings point to that infant being more prone to early-onset asthma. […] Whats most important to consider, is that GERD should be diagnosed and managed as early as possible to prevent potential long-term pulmonary complications, says Dr. Pirzada. Our promising research may lead us to better diagnose the risks of asthma in many young patients, allowing us to take precautions to avoid triggering that chronic condition that can last a lifetime.

• #52 Infant reflux | Better Health Channel

  https://www.betterhealth.vic.gov.au/conditions-and-treatments/infant-reflux

  In babies with GORD, your doctor might prescribe medication to help treat these symptoms. […] If your baby has reflux, but not GORD, there are no medications that can help. […] Babies with GORD are sometimes given medications to help reduce stomach acid. […] As with any medication, there are potential risks and side effects for babies. […] Taking medications for GORD means that babies may be at risk of the following compared to babies who do not take these medications: 3 to 6 times more likely to develop gastroenteritis (gastro) and pneumonia, 4 times more likely to not get enough nutrients from their food, almost 2 times more likely to have a bone fracture later in life, 2 times more likely to get an infection that causes severe diarrhoea (known as Clostridium difficile infection), 1.5 times more likely to develop asthma as a child. […] Although there are no medications available, these strategies may help: Remember, if your baby is vomiting but is otherwise happy and growing well, there is no need to worry.

• #53 Infant reflux | Better Health Channel

  https://www.betterhealth.vic.gov.au/conditions-and-treatments/infant-reflux

  In babies with GORD, your doctor might prescribe medication to help treat these symptoms. […] If your baby has reflux, but not GORD, there are no medications that can help. […] Babies with GORD are sometimes given medications to help reduce stomach acid. […] As with any medication, there are potential risks and side effects for babies. […] Taking medications for GORD means that babies may be at risk of the following compared to babies who do not take these medications: 3 to 6 times more likely to develop gastroenteritis (gastro) and pneumonia, 4 times more likely to not get enough nutrients from their food, almost 2 times more likely to have a bone fracture later in life, 2 times more likely to get an infection that causes severe diarrhoea (known as Clostridium difficile infection), 1.5 times more likely to develop asthma as a child. […] Although there are no medications available, these strategies may help: Remember, if your baby is vomiting but is otherwise happy and growing well, there is no need to worry.

• #54 Babies and reflux: stress of diagnosis – how Peptest can help

  https://www.peptest.co.uk/babies-reflux-diagnosis-stress-mothers/

  “Clinical studies have investigated the use of our saliva diagnostic test Peptest with children, so we can bring a simpler and quicker method of diagnosis. Peptest can be used to identify reflux in babies and prevent the unnecessary use of PPIs, as well as reducing the stress that reflux causes to both babies and their parents.” […] “Pepsin can be detected in gastric /oral secretion collected from babies and in the saliva from older children.”

• #55 Babies and reflux: stress of diagnosis – how Peptest can help

  https://www.peptest.co.uk/babies-reflux-diagnosis-stress-mothers/

  “Clinical studies have investigated the use of our saliva diagnostic test Peptest with children, so we can bring a simpler and quicker method of diagnosis. Peptest can be used to identify reflux in babies and prevent the unnecessary use of PPIs, as well as reducing the stress that reflux causes to both babies and their parents.” […] “Pepsin can be detected in gastric /oral secretion collected from babies and in the saliva from older children.”

• #56 Diagnosis and Treatment of Gastroesophageal Reflux in Infants and Children – PubMed

  https://pubmed.ncbi.nlm.nih.gov/26554410/

  Gastroesophageal reflux is defined as the passage of stomach contents into the esophagus with or without accompanied regurgitation (spitting up) and vomiting. […] The diagnoses of gastroesophageal reflux and GERD are based on the history and physical examination. Diagnostic tests, such as endoscopy, barium study, multiple intraluminal impedance, and pH monitoring, are reserved for when there are atypical symptoms, warning signs, doubts about the diagnosis, or suspected complications or treatment failure. […] In infants, most regurgitation resolves by 12 months of age and does not require treatment. […] Histamine H2 receptor antagonists and proton pump inhibitors are the principal medical therapies for GERD. They are effective in infants, based on low-quality evidence, and in children and adolescents, based on low- to moderate-quality evidence.

• #57 Gastroesophageal Reflux in Infants – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/gastrointestinal-disorders-in-neonates-and-infants/gastroesophageal-reflux-in-infants

  Gastroesophageal reflux is the movement of gastric contents into the esophagus. […] Diagnosis is often made clinically and could include a trial of dietary change or in some instances a trial of acid-suppressing medication, but some infants require an upper gastrointestinal contrast x-ray series, use of esophageal pH and impedance probes, and sometimes endoscopy. […] Diagnosis of Reflux in Infants includes clinical evaluation, typically upper gastrointestinal (GI) series, and sometimes esophageal pH measurement or endoscopy. […] Infants who have symptoms consistent with GERD but no severe complications may be given a therapeutic trial of acid-reducing medication for GERD. […] If the diagnosis remains unclear or there is still a question of whether reflux is actually the cause of symptoms such as coughing or wheezing, a pediatric gastroenterologist may do tests using esophageal pH or impedance probes.

• #58 Patient education: Acid reflux (gastroesophageal reflux) in babies (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/acid-reflux-gastroesophageal-reflux-in-babies-beyond-the-basics

  Gastroesophageal reflux (GER) is the medical term for spitting up. It occurs when the stomach contents reflux or back up into the esophagus and/or mouth. Because the stomach naturally produces acid, reflux is sometimes called „acid reflux”; other terms include „regurgitation” and „spilling.” […] In contrast, in a few babies, GER causes complications. In this case, the condition is known as gastroesophageal reflux disease, or „GERD.” Babies with proven GERD may require treatment. […] Testing is not usually necessary for babies with uncomplicated reflux. They should be evaluated if the symptoms worsen, appear for the first time after six months of age, or do not improve by the time they are 18 to 24 months of age. […] Possible gastroesophageal reflux disease — In a few babies, reflux causes complications, such as irritation or damage to the esophagus, asthma, or recurrent pneumonia. In these cases, the condition is called gastroesophageal reflux disease, or „GERD.” This only occurs in a small percentage of babies who spit up frequently.

• #59 Over-diagnosis of reflux in infants leads to needless medication, research finds | ScienceDaily

  https://www.sciencedaily.com/releases/2013/04/130401104403.htm

  Medications used to treat gastroesophageal reflux disease, or GERD, are some of the most widely used medications in children less than one year old. […] Physicians often label common symptoms in infants, such as crying and spitting up, as disease. […] Frequent use of the GERD label can lead to overuse of medication. […] The study found that doctors’ use of the label GERD prompted parents to request medication for their baby even when they had been advised that the medication would probably be ineffective. […] Over-diagnosis of GERD can make a medical condition out of a normal behavior. […] The discomfort can cause the infant to cry, but it is not necessarily a disease. […] Parents can learn from this study that a disease label can make them want medication for their child, regardless of whether the drugs are effective or not. […] Unnecessary use of medication is costly. […] The long-term side effects of the medication frequently prescribed to children diagnosed with GERD have not been fully studied.

• #60 Gastrooesophageal reflux disease in infants

  https://www.rch.org.au/clinicalguide/guideline_index/Gastrooesophageal_reflux_disease_in_infants/

  Gastro-oesophageal reflux disease (GORD) should be differentiated from physiological gastro-oesophageal reflux, which is common in healthy, thriving babies and does not require specific investigations or management. […] Both GOR and GORD can be diagnosed on detailed history and examination. […] Investigations for GORD (such as barium contrast radiography, pH probe, endoscopy) are rarely necessary, and are not diagnostic. Investigations should only be considered on an individual basis after the patient has been assessed by a paediatrician. […] There is no evidence to support empiric use of acid-suppressant therapy as a diagnostic trial for irritable infants.

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