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(Pediatrics in Review. 2008;29:317-320.)
© 2008 American Academy of Pediatrics

Focus on Diagnosis

New Technologies for the Diagnosis of Gastroesophageal Reflux Disease

The first 300 words of the full text of this article appear below.

	Introduction

 
Gastroesophageal reflux (GER), the regurgitation of gastric contents into the esophagus or mouth, is a common phenomenon among healthy infants, with approximately 50% of 0- to 3-month-old infants and 67% of 4-month-old infants experiencing at least one episode of vomiting per day. GER typically improves through the first postnatal year, with only 5% of healthy 12-month-olds experiencing vomiting. Uncomplicated GER usually can be diagnosed from the history and physical examination, and treatment often is instituted without extensive diagnostic testing.

When symptoms do not respond to treatment as expected, symptoms persist much beyond 1 year of age, GER is suspected to be the cause of epigastric abdominal pain or substernal pain, or extraesophageal symptoms are present (eg, poor weight gain, apparent life-threatening episodes [ALTEs], apnea, pneumonia, treatment-resistant asthma, or chronic cough), GER often is called "complicated GER" or gastroesophageal reflux disease (GERD). GERD has been reported to affect up to 8% of infants and children. When GERD is suspected, diagnostic testing often is warranted.

A commonly employed test, the upper gastrointestinal (GI) barium study, can rule out anatomic abnormalities of the upper GI tract, such as malrotation, but only captures one moment in time. The upper GI barium study lacks sensitivity (31% to 86%) and specificity (21% to 83%) for diagnosis of pathologic GER compared with the gold standard of 24-hour intraesophageal pH monitoring.

Similarly, although the gastric scintiscan provides useful information about gastric emptying and may detect episodes of GER and pulmonary aspiration, its utility is limited by poor sensitivity compared with 24-hour pH monitoring (15% to 59%), a lack of standardized technique, and the absence of age-normative data.

Intraesophageal pH monitoring, a test that documents esophageal exposure to refluxed gastric contents over a longer period of time, and the ability to correlate reflux episodes with the symptoms in question . . . [Full Text of this Article]