The diagnosis and treatment of gastro-oesophageal reflux disease in infants and children.

Gastro-oesophageal reflux is a common phenomenon in infants, and is an aspecific complaint. The balance between negligence and overconcern is therefore very difficult to make, and requires experienced physicians. The approach in infants with uncomplicated reflux consists of non-drug treatment and reassurance of the parents about the almost physiological nature of the regurgitations of the baby. If the parents persist in their complaints, the administration of prokinetics such as cisapride can be considered before performing investigations (oesophageal pH monitoring). The efficacy and the lack of side-effects of cisapride makes this the drug of choice. The frequency of side-effects of other drugs necessitates the diagnosis of reflux disease before their administration. Upper gastrointestinal tract endoscopy is the investigation of choice in children suspected of reflux oesophagitis. In the majority of cases, the efficacy of cisapride, H2-blockers and Na-K-ATP-ase-blockers should be given a chance. Unusual presentations, such as chronic respiratory disease, as a manifestation of reflux disease should be confirmed with oesophageal pH monitoring.