Gastroesophageal reflux disease: Review of presenting symptoms, evaluation, management, and outcome in infants

We conducted a retrospective review of 342 infants presenting with symptoms suggestive of gastroesophageal reflux disease (GERD) to assess their evaluation, management, and outcome. All infants underwent extended pH monitoring (EPM) for one or more of the following symptoms: regurgitation, choking, irritability, failure to thrive, apparent life-threatening event, or wheezing. EPM was considered abnormal if distal reflux index was ≥5% and/or if the Euler and Byrne score was ≥50 and these patients were labeled as having GERD. Those with normal EPM parameters were controls. All infants were <1 year of age (198 boys, 144 girls). Most received conservative treatment with formula changes and/or thickening and positional management before EPM. Of 342 infants studied, EPM was normal in 169 patients, ie, controls, and GERD was present in 173 children. GERD was more prevalent in Caucasians compared to African Americans (P < 0.045). Although a prokinetic or acid suppression medication or both were given more commonly in infants with GERD, almost half of infants in the control group also needed pharmacotherapy because of persistent symptoms. Mean time to resolution of symptoms in the control group infants with normal EPM was 3.5 months, and in infants with GERD it was 5.4 months (P < 0.001). In conclusion, the Majority of infants with symptoms suggestive of GERD resolve their symptoms within 3-6 months of initiating treatment. Day-to-day variability of the spectrum of GERD may contribute towards normal results of EPM in some infants who need pharmacotherapy.