GERD acid reflux in children

Diagnostic Evaluation in children:-

 In an older child or adolescent with symptoms consistent with typical reflux syndrome, a 4-week trial of therapy can be commenced empirically . If no improvement in symptoms occurs, the patient should be referred to a pediatric gastroenterologist for further diagnostic evaluation. If symptoms improve with lifestyle changes and/or other ther-apeutic intervention, treatment can be safely continued for 2–3 months and then weaned and ceased. If symptoms recrudesce upon cessation of therapy, referral should be made to a pe-diatric gastroenterologist for further assessment.( Vakil N,, et al , 2006)

Many diagnostic tests can assist in confirming the presence or absence of GERD, although no single test can uniformly detect this condition. These include pH monitoring and mul-tiple intraluminal impedance monitoring, which are often per-formed as a combined investigation. The former provides information regarding the frequency and duration of esoph-ageal reflux episodes, whilst the latter detects changes in lumi-nal contents such as the gas, food, and fluid passage. These tests may be helpful in diagnosing and managing GERD, but their role in determining disease severity, progression, and response to therapy is yet to be determined in the pediatric population.( Sherman PM, et al , 2009)

Endoscopy allows visualization and biopsying of the esoph-ageal mucosa that, most importantly, can assist in excluding diagnoses other than GERD. Readily available tests such as contrast esophagography (barium swallow) and ultrasonography have no role in diagnosing GERD but may be helpful in as-sessing the complications of GERD, such as stricture for-mation, as well as other differential diagnoses or anatomical abnormalities. In general, if a clinical diagnosis of reflux disease cannot be made or if a trial of therapy is not efficacious, referral should be made to a pediatric gastroenterologist for evaluation and de-termination of the most appropriate diagnostic investigations. .( Sherman PM, et al , 2009)