Study
Usefulness
Observations
Esophageal pH-metry
Evaluates the presence of acidic fluid
Useful to evaluate anti-GER treatment
Does not detect mildly acidic or non-acidic fluids
Esophageal pH-metry multichannel intraluminal impedance
Evaluates the presence of acid, mildly acidic, and non-acid reflux
Useful to evaluate the effectiveness of anti-GER treatment and its association with extradigestive symptoms (cough, difficult-to-control asthma, chest pain)
Impedance normal values for pediatric age are missing
Esophagus-duodenum-stomach x ray
Anatomical evaluation when malformations are suspected
Should not be used to diagnose GER or quantity of
Gastric endoscopy
Evaluation of macroscopic signs of esophagitis and taking of histological samples for differential diagnosis of other pathologies (eosinophilic esophagitis)
If no macroscopic alterations are found it may not diagnose GER
Flexible laryngoscopy
Evaluates the anatomy of the aerodigestive way and macroscopic signs of laryngopharyngealreflux
Findings are not necessarily related to GER
Gastroesophageal scintigraphy
Evaluation of postprandial and aspiration GER
Lack standardization technique and normal values for each age
Treatment
There are pharmacological and non-pharmacological measures for patients with confirmed disease caused by gastroesophageal reflux. For pediatric patients, the strategy of “empirical treatment” with no clear symptoms of GER has not been confirmed as sensitive or specific for the diagnosis of this disease, and therefore it is not recommended as a diagnosis method.
Use of thick or “anti-regurgitation” formulas, although they reduce the number of regurgitations observed by the caregivers, is not translated in pH-metry improvement. Formula thickened at home with rice cereal increases weight in infants, considering the caloric density it involves.
In older children and adolescents, weight reduction is recommended in children with excess malnutrition. Although suspending certain foods a priori is a commonly used strategy, it has not been confirmed that it actually reduces GER episodes. Instead, it is recommended to reduce certain foods according to each case.
It has been shown that prone and lateral decubitus position reduces GER episodes. Nevertheless, these positions have been associated with an increased rate in sudden death syndrome, and therefore supine position is recommended for those patients who are under 1 year of life and also have GER. Prone position can be kept when they are awake and always supervised.
In relation to pharmacological measures, there are medications that have a buffer effect on the acid, a barrier effect on the mucosa, anti-acid secretors, and prokinetics.
Evidence about pediatric use of antacids is limited, and special care must be taken with those drugs containing aluminum, in relation to milk-alkali syndrome. They are generally not recommended for the treatment of GER in children.
Gastroesophageal reflux treatment
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