Mohan Neelam, Matthai John, Bolia Rishi, Agarwal Jaya, Shrivastava Rimjhim, Borkar Vibhor Vinayak
Medanta The Medicity, Gurugram, Haryana.
Masonic Medical Centre for Children, Coimbatore, Tamil Nadu. Correspondence to: Dr John Matthai, Masonic Medical Centre for Children, Coimbatore, Tamil Nadu.
Indian Pediatr. 2021 Dec 15;58(12):1163-1170. Epub 2021 Jun 28.
Gastroesophageal reflux (GER) related symptoms are a major cause of parental concern and referrals at all ages. These guidelines have been framed to inform pediatricians regarding current diagnosis and management of gastro-esophageal reflux disease (GERD).
A group of experts from the pediatric gastroenterology sub-specialty chapter of Indian Academy of Pediatrics (ISPGHAN) discussed various issues relating to the subject online on 25 October, 2020. A consensus was reached on most aspects and a writing committee was constituted. This committee had three meetings for a detailed discussion. The statement was sent to the entire group and their approval obtained.
To formulate a consensus statement to enable proper diagnosis and management of GERD in children.
GER is physiological in most infants and it improves as age advances. The pathological form, called GERD causes distressing symptoms that affect daily activities and may result in complications. The presentation would vary from regurgitation to severe symptoms due to esophageal or respiratory tract disease. In older children, esophagitis is the commonest manifestation of GERD. A careful history and clinical examination are adequate to make a diagnosis in most patients, but judicious investigations are necessary in a few. Upper gastro intestinal tract endoscopy may be required in those with esophageal manifestations, dysphagia and hematemesis. In children with extra-esophageal symptoms, MII-pH monitoring and scintigraphy are necessary. Empirical treatment with a Proton pump inhibitor (PPI) has not been proven useful in infants, but a four-week trial is recommended in older children without complications. While positioning and feed thickening have limited benefit in infants, life-style modifications are important in older children.
胃食管反流（GER）相关症状是各年龄段家长担忧和转诊的主要原因。制定这些指南旨在让儿科医生了解胃食管反流病（GERD）的当前诊断和管理方法。
印度儿科学会儿科胃肠病学亚专业分会（ISPGHAN）的一组专家于2020年10月25日在线讨论了与该主题相关的各种问题。在大多数方面达成了共识，并成立了一个写作委员会。该委员会召开了三次会议进行详细讨论。声明已发送给整个小组并获得他们的批准。
制定一项共识声明，以实现对儿童GERD的正确诊断和管理。
大多数婴儿的GER是生理性的，随着年龄增长会改善。称为GERD的病理性形式会引起令人痛苦的症状，影响日常活动，并可能导致并发症。表现形式从反流到因食管或呼吸道疾病引起的严重症状各不相同。在大龄儿童中，食管炎是GERD最常见的表现。仔细的病史和临床检查足以对大多数患者做出诊断，但少数患者需要进行明智的检查。有食管表现、吞咽困难和呕血的患者可能需要进行上消化道内镜检查。有食管外症状的儿童需要进行多通道腔内阻抗-pH监测和闪烁扫描。质子泵抑制剂（PPI）的经验性治疗在婴儿中尚未被证明有效，但对于无并发症的大龄儿童建议进行为期四周的试验。虽然体位调整和奶液增稠对婴儿的益处有限，但生活方式的改变对大龄儿童很重要。
