DIAGNOSIS

The diagnosis of GERD is often made clinically based on the bothersome symptoms or signs that may be associated with GER (Table 1). However, subjective symptom descriptions are unreliable in infants and children younger than 8 to 12 years of age, and many of the purported symptoms of GERD in infants and children are nonspecific. The diagnosis of GERD is inferred when tests show excessive frequency or duration of reflux events, esophagitis, or a clear association of symptoms and signs with reflux events in the absence of alternative diagnoses.

Although many tests have been used to diagnose GERD, few studies compare their utility. Importantly, it is not known whether tests can predict an individual patient’s response to therapy. Tests are useful to document the presence of pathologic reflux or its complications to establish a causal relation between reflux and symptoms, to evaluate therapy, and to exclude other conditions. Because no test can address all of these questions, tests must be carefully selected according to the information sought, and the limitations of each test must be recognized.

TABLE 1. Symptoms and signs listed in the 2009 NASPGHAN Guidelines that may be associated with gastroesophageal reflux.

Symptoms

Recurrent regurgitation with/without vomiting

Weight loss or poor weight gain

Irritability in infants

Ruminative behavior

Heartburn or chest pain

Hematemesis

Dysphagia, odynophagia

Wheezing

Stridor

Cough

Hoarseness

Signs

Esophagitis

Esophageal stricture

Barrett esophagus

Laryngeal/pharyngeal inflammation

Recurrent pneumonia

Anemia

Dental erosion

Feeding refusal

Dystonic neck posturing (Sandifer syndrome)

Apnea spells

Apparent life-threatening events