Updated treatment options for gastroesophageal reflux disease in children: practical guide for clinicians.

INTRODUCTION

Pediatric reflux esophagitis (RE) lies within the gastroesophageal reflux disease (GERD) spectrum but differs from adults in pathophysiology, presentation, and therapy risk - benefit. Clear, age-aware guidance is needed.

AREAS COVERED: This narrative review synthesizes guidelines and studies on diagnosis and management of pediatric RE. We outline indications for endoscopy with biopsy and ambulatory monitoring (pH for acid burden; pH-impedance for nonacid reflux and symptom association, especially under acid suppression or in infants). First-line care prioritizes feeding optimization, thickeners, targeted allergy evaluation, and safe positional advice. Pharmacotherapy is summarized with emphasis on efficacy and safety: proton-pump inhibitors for documented esophagitis in children ≥1 year; H2-receptor antagonists for short-term or step-down use; alginates for post-prandial symptoms or mild disease; emerging potassium-competitive acid blockers under pediatric evaluation; and selective prokinetics/baclofen in refractory, dysmotility-predominant cases. Surgical options are addressed for proven, complicated, or refractory disease. Literature was identified in PubMed/Embase through 2025 using predefined pediatric GERD/RE, diagnostics, pharmacotherapy, safety, and surgery keywords.

EXPERT OPINION: An age-aware, stepwise strategy - non-pharmacologic first, time-limited proton pump inhibitors with planned step-down, and cautious adjuncts - optimizes outcomes while minimizing harm. Priorities include pediatric trials for potassium-competitive acid blockers (P-CABs) and alginates, validated deprescribing pathways, noninvasive biomarkers, and scalable care models.