Gastroesophageal reflux in children: clinical manifestations, diagnosis, pathophysiology, and therapy.

Gastroesophageal reflux in infants and children is a challenging diagnostic problem. A careful history and physical examination are of foremost importance. In infants, the esophageal manometry study and the Tuttle test are helpful in confirming gastroesophageal reflux. In older children, these two studies as well as the Bernstein test should be done to document reflux. The presence of esophagitis or esophageal strictures is best determined by esophagoscopy with concomitant grasp or suction biopsies. A medical regimen should be tried for three to six weeks in all children except those with esophageal strictures or severe malnutrition. Medical failures should be treated surgically with Nissen fundoplications, performed by a competent pediatric surgeon. The prognosis for children undergoing surgical correction is excellent.