introduction to gastroesophageal reflux (gerd)


 GER is a normal physiological event that occurs when transient relaxation of the lower esophageal sphincter (LES) allows retro-grade passage of gastric contents into the esophagus and beyond. This may occur with or without regurgitation and/or vomiting. The frequency with which reflux occurs, and the duration of events, varies with age, with infants experiencing many more ep-isodes than older children and adolescents. By 12–14 months of life, reflux episodes have normally significantly declined and it is unusual for children older than 18 months to experience clinically significant issues related to physiological reflux.( Nelson SP, et al ,2009)  In contrast,

GERD is a pathological process whereby reflux results in troublesome symptoms and/or complications. Other terms such as ‘regurgitation’, ‘vomit’, and ‘rumination’ are de-scriptive terms, and whilst they may be symptoms of reflux, they do not necessarily constitute a diagnosis of GER or GERD.( Sherman PM, et al ,2009)  In 2006, the Montreal definition of GERD was established providing an international evidence-based consensus on the definition of GERD in the adult population. In 2009, a similar global consensus on the definition of GERD in the pediatric population was developed, with 59 consensus state-ments and recommendations made. ( Sherman PM, et al ,2009)



Figure 13: gastroesophageal reflux disease

Determining GERD in the neonatal and infant group is challenging because of the potential differential diagnoses and the highly variable presentation. Determining reflux from re-flux disease requires significant clinical acumen. To this extent, it may be considered a separate topic for review. As such, this paper will focus on GERD in children (ages 1–10 years) and adolescents (ages 11–17 years).( Hollingworth S,,2010)