Diagnosis of gastroesophageal reflux in pediatrics.

Gastroesophageal reflux (GER) may be normal, functional, or pathogenic. Normal GER is of short duration and seen in all individuals. Functional GER, or effortless regurgitation, is common during infancy, causing no ill effects. Pathogenic GER causes diseases such as failure-to-thrive, coughing, choking, aspiration, apnea and/or bradycardia, esophagitis with irritability and excessive crying. Clinically it becomes imperative to distinguish normal and functional from pathogenic GER. The tests presently employed to detect GER are roentgenogram of the upper gastrointestinal tract (showing barium GER), scintigraphy of the esophagus after ingestion of a 99mTc labeled meal (indicating meal GER) and prolonged pH probe monitoring the lower esophagus (depicting acid GER). There seems to be a controversy regarding the usefulness of these tests for the diagnosis of pathogenic GER. In the present study of 89 infants and children presenting with signs and symptoms of pathogenic GER, 70% had significant acid GER, while 36% and 17% had barium and meal GER respectively. No statistically significant correlations were detected between acid GER, barium GER, and meal GER. We conclude that these three tests probably represent different phenomena, and that prolonged esophageal pH monitoring should be considered the most reliable and gold standard for detection of pathogenic GER.