Gastro-oesophageal reflux in children.

Disordered motility of the gastrointestinal tract in children is usually manifest as gastro-oesophageal reflux disease. Reflux is common in infants but usually resolves spontaneously with time. If severe enough to merit investigation, 24-hour ambulant oesophageal pH monitoring is the most widely used investigation, though it does have disadvantages. Upper gastrointestinal endoscopy and biopsy may be required to diagnose oesophagitis. Treatment follows a step-wise approach, progressing from positioning and feed-thickening in infants, through to pharmacological management with prokinetic agents and/or acid-suppression, and surgery for a very small proportion of children whose symptoms do not respond to optimal medical therapy.