Gastroesophageal reflux is a frequent,nonspecific phenomenon in infants and children. Therecommended approach for infants with uncomplicated regurgitationis the reassurance of the parents about the physiological natureof excessive regurgitation, and if necessary, completed withdietary recommendations for formula-fed infants. If, despite theseefforts, the symptoms persist, the administration of prokineticssuch as cisapride is recommended before investigations such asesophageal pH monitoring are begun. Cisapride is the drug ofchoice because it has the best efficacy and safety profile. In infantsand children presenting with symptoms that suggest esophagitis,endoscopy of the upper gastrointestinal tract is recommended. Ifthere is severe esophagitis, acid suppression with H2 receptor antagonistsor proton pomp inhibitors is recommended, eventuallyin combination with prokinetics. In life-threatening situations, orin patients who are resistant to or dependent on acid suppressivemedication, a surgical procedure such as laparoscopic Nissenshould be considered.
展开▼
