Gastroesophageal reflux (GOR) is a normal physiological event but becomes pathological when frequency or duration is increased or/and there are detrimental effects when it may be termed Gastro Esophageal Reflux Disease (GORD). GORD can present with unusual symptoms such as apnoeas, apparent life threatening event and sudden infant death syndrome. Food allergy may present as GORD. In most children GORD is diagnosed on clinical symptoms and investigations are reserved for difficult cases. Esophageal pH monitoring is the "gold standard" and records reflux index (RI) defined as percentage time the oesophagus is acid. Simultaneous monitoring of esophageal and gastric pH (dual probe), by documenting the time when stomach is not acid, may help to improve the accuracy of assessing GOR. Non-acid reflux can be measured by using impedance studies. Treatment of GORD includes positional and dietary advice, drugs to improve gastric emptying and reduce gastric acid secretion and surgery. Prone position is not recommended as it increases risk of sudden infant death syndrome. Prokinetics are often used although efficacy evidence is weak. Possibility of rebound hypersecretion should be taken into account when stopping gastric acid suppressants and dose reduction in a stepwise manner is recommended. Cytochrome P450 isoform CYP2C19 has greater affinity to the Proton Pump Inhibitor (PPI). The phenotype is present in 3-5% Caucasian population but rises to 15-20% in the Asian population. Other drugs that may be helpful in very difficult clinical scenarios include Erythromycin, Baclofen, Ondansetron, Tegaserod and Prucalopride.
