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Gastroesophageal Reflux in Infants:  More Than Just a pHenomenon

Rachel Rosen, MD, MPH1
[+] Author Affiliations
1Aerodigestive Center, Boston Children’s Hospital, Boston, Massachusetts
JAMA Pediatr. 2014;168(1):83-89. doi:10.1001/jamapediatrics.2013.2911.
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Published online

Importance  Rarely have the best methods of diagnosis or the treatment of a disease engendered more controversy than gastroesophageal reflux (GER), a highly prevalent condition in infants.

Objective  To discuss the latest controversies in the diagnosis and treatment of GER in infants.

Evidence Review  All articles related to the diagnosis and treatment of GER were reviewed and, whenever possible, literature about infants was weighted with greater importance than literature about older children and adults.

Findings  Although as many as 60% of infants have signs of GER, the role of GER in causing disease is difficult to elucidate. Despite new diagnostic tools to detect acid and nonacid reflux, our understanding of the relationship between reflux events and symptoms is complex. Furthermore, acid suppression, the mainstay of therapy for GER, increases the burden of nonacid reflux, which is already much higher in infants than in older children and which may worsen symptoms. Therefore, more conservative therapies are recommended for symptomatic infants.

Conclusions and Relevance  Although GER is a common reason for visits to primary care providers and specialists, few data suggest that GER results in many of the symptoms to which it has been attributed. A strong shift away from acid-suppression therapy in infants has occurred because of the adverse effects, lack of efficacy, and increase of nonacid reflux burden relative to acid burden. Nonpharmacologic measures should be used whenever possible because most infant GER will resolve without intervention.

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Figure.
Examples of Multichannel Intraluminal Impedance With pH

Reflux episodes (shaded areas) are shown as drops in impedance channels (IMPs, given in ohms) moving from the distal IMPs up the esophagus in a retrograde fashion (arrows). A, In an acid reflux episode, the lowest channel, pH, drops to levels less than 4 (dashed line). B, In a nonacid reflux episode, no drop in pH level is seen.

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