Recognizing pathological reflux

Kam Choy Chen
Tunku Azizah Hospital, Kuala Lumpur, Malaysia

Gastroesophageal Reflux (GER) is the passage of gastric contents into the esophagus, with or without regurgitation or vomiting. In infants, GER is often a physiological process and typically resolves with age. However, when it leads to troublesome symptoms that interfere with daily functioning or causes complications in the esophagus or other systems, it is termed Gastroesophageal Reflux Disease (GERD).

Several mechanisms contribute to GER, including transient relaxation of the lower esophageal sphincter, anatomical immaturity or defects, and gastrointestinal motility disorders.

Recognizing red flag signs is crucial, as they may indicate more severe disease or other conditions mimicking GERD. These include excessive irritability, constitutional symptoms (such as weight loss, fever, or lethargy), onset of GER after 6 months of age or persistence beyond 1 year, forceful or bilious vomiting, hematemesis, and the presence of neurological abnormalities.

Diagnosis is often clinical, but certain investigations may support the diagnosis or rule out other conditions. These include pH-impedance monitoring, abdominal ultrasound, and upper gastrointestinal contrast studies to exclude anatomical abnormalities contributing to reflux.

Management is based on the severity of the condition and includes non-pharmacological measures (such as feeding modifications and positioning), pharmacological treatments (like acid suppressants), and in severe or refractory cases, surgical intervention.