Gastroesophageal reflux disease in childhood and adolescence

Symptoms, diagnostic and therapeutic procedures, as well as the long-term prognosis of gastroesophageal reflux disease (GERD) show considerable differences in pediatric patients depending on their respective age. Particularly in infants symptoms are often unspecific, and differentiation is difficult between GERD, physiological reflux, and cows' milk protein allergy. Patients with a high risk of GERD are children with a cerebral palsy or after repair of esophageal atresia, in whom the indication for upper endoscopy must be considered. Other diagnostic methods should be complementary applied according to age, symptoms, and the problem in question. Proton pump inhibitors are the first choice medication for children with proven GERD. However, in infants and young children, they should not be used without prior investigation. The need for antireflux surgery should be judged by a pediatric gastroenterologist together with a pediatric surgeon.