[Measuring gastroesophageal reflux in children].

The risk of gastroesophageal reflux in children has been recognized in many situations, particularly in ear, nose and throat affections and in chronic recurrent respiratory diseases. In addition, in the sudden infant death, a certain number of malaises may be directly related to gastroesophageal reflux via a vagal mechanism. Search for improved comfort for babies exposed to painful oessophagitis is another reason for careful evaluation, particularly since effective treatment is available. The evaluation of gastroesophageal reflux aims at identifying the underlying mechanism. Simultaneous recordings of lower sphincter pressures and pH variations demonstrate the essential role of inappropriate sphincter activity. Oesophagitis results from both prolonged exposure to acid and probably to pepsin, leading to local inflammation. The oesophagitis in turns aggravates sphincter hypotonicity. The oesophageal orifice of the diagphragm could also be involved. The clinical examination is essential to distinguish among the myriad of signs observed in infants and children with suspected reflux. When the symptomatology is particularly scant or when the general health status is unaffected further exploration may not be required. If however, respiratory manifestations appear to be a complication of reflux, complimentary tests are needed. While the diagnosis may be confirmed with pH metry, fibroscopy may be needed to evaluate the anatomical situation and the effect of the oesophagitis on the upper digestive tract. Much progress has also been made with endoscopic explorations which can identify cardial insufficiency and precisely describe the anatomy of the hiatal region. Treatment relies basically on prokinetic agents. The effectiveness of postural measures are currently questioned.