Hamdan Medical Journal (previously the Journal of Medical Sciences)

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Gastroesophageal Reflux Disease (GERD) in Children: From Infancy to Adolescence

Sulaiman Bharwani
Published in : Journal of Medical Sciences ; Vol 4, No 1 (2011)
DOI : 10.2174/1996327001104010025


The increased recognition of the difference between the adult and the pediatric populations in terms of the manifestation and the management of gastroesophageal reflux disease (GERD), owes much to the number and nature of high quality clinical research and drug trials conducted in the past decade. The plethora of choices available to treat GERD is unprecedented. A primary care physician clearly understands the investigative and therapeutic options available, and some of the risks associated with them. What makes the physician wary is the absence of a) a clear objective definition of gastroesophageal reflux disease (GERD) in a pediatric population and b) sufficient data to support the use of the armamentarium available. The variety of definitions and terms used in the literature to define GERD adds to the confusion and results in a variety of approaches to manage it. In light of the new developments, the objective of the review is threefold, 1) to simplify as much as possible the current evidence based pediatric literature in defining GERD and its common presentations in the three distinct sub-populations of children as newborns and infants (0-12 months), toddlers and children (1-10 years), and adolescents (11-18 years). These cut-off periods are arbitrary and some overlap is inevitable, 2) to review the diagnostic and therapeutic tools available today, and 3) to effectively apply these tools and formulate pathways in some case scenarios, for the esophageal and extra esophageal GERD manifestation in the three distinct age groups specified above.


Gastroesophageal; reflux; esophagitis; guidelines

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Sherman PM, Hassall E, Fagundes-Neto U, Gold BD, Kato S, Koletzko S, et al. A global evidence-based consensus on the definition of gastroesophageal reflux disease in children. Am J Gastroenterol 2009; 104: 1278-95.

Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R; Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-20.

Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal refluxduring infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 1997; 151: 569-72.

Martin AJ, Pratt N, Kennedy JD, Ryan P, Ruffin RE, Miles H, et al. Natural history and familial relationships of infant spilling to 9 years of age. Pediatrics 2002; 109: 1061-7.

Miyazawa R, Tomomasa T, Kaneko H, Tachibana A, Ogawa T, Morikawa A. Prevalence of gastro- esophageal reflux-related symptoms in Japanese infants. Pediatr Int 2002; 44: 513-6.

Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 2006; 130: 1527-37.

Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 2006; 130: 1519-26.

Hetzel DJ, Dent J, Reed WD, Narielvala FM, Mackinnon M, McCarthy JH. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterology 1988; 95: 903-12.

Hassall E, Israel D, Shepherd R, Radke M, Dalväg A, Sköld B, et al. Omeprazole for treatment of chronic erosive esophagitis in children: a multicenter study of efficacy, safety, tolerability and dose requirements. International Pediatric Omeprazole Study Group. J Pediatr 2000; 137: 800-7.

Boccia G, Manguso F, Miele E, Buonavolontà R, Staiano A. Maintenance therapy for erosive esophagitis in children after healing by omeprazole: is it advisable? Am J Gastroenterol 2007; 102: 1291-7.

Gunasekaran TS, Hassall EG. Efficacy and safety of omeprazole for severe gastroesophageal reflux in children. J Pediatr 1993; 123: 148-54.

Fass R. Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol 2007; 41: 131-7.

Dent J, Brun J, Fendrick A, Fennerty M, Janssens J, Kahrilas P, et al. An evidence-based appraisal of reflux disease management␣the Genval Workshop Report. Gut 1999; 44 (Suppl 2): S1-S16.

Klauser AG, Schindlbeck NE, Muller-Lissner SA. Symptoms in gastro- oesophageal reflux disease. Lancet 1990; 335: 205-8.

Venables TL, Newland RD, Patel AC, Hole J, Wilcock C, Turbitt ML. Omeprazole 10 milligrams once daily, omeprazole 20 milligrams once daily, or ranitidine 150 milligrams twice daily, evaluated as initial therapy for the relief of symptoms of gastro- oesophageal reflux disease in general practice. Scand J Gastroenterol 1997; 32: 965-73.

Richter JE, Kovacs TO, Greski-Rose PA, Huang section sign B, Fisher R. Lansoprazole in the treatment of heartburn in patients without erosive oesophagitis. Aliment Pharmacol Ther 1999; 13: 795-804.

DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. The Practice Parameters Committee of the American College of Gastroenterology. Am J Gastroenterol 1999; 94: 1434-42.

Müller S, Pühl S, Vieth M, Stolte M. Analysis of symptoms and endoscopic findings in 117 patients with histological diagnoses of eosinophilic esophagitis. Endoscopy 2007; 39: 339-44.

Hassall E, Kerr W, El-Serag HB. Characteristics of children receiving proton pump inhibitors continuously for up to 11 years duration. J Pediatr 2007; 150: 262-7.

Romero Y, Cameron AJ, Schaid DJ, McDonnell SK, Burgart LJ, Hardtke CL, et al. Barrett's esophagus: prevalence in symptomatic relatives. Am J Gastroenterol 2002; 97: 1127-32.

Trudgill N. Familial factors in the etiology of gastroesophageal reflux disease, Barrett's esophagus, and esophageal adenocarcinoma. Chest Surg Clin N Am 2002; 12: 15-24.

Hassall E. Co-morbidities in childhood Barrett's esophagus. J Pediatr Gastroenterol Nutr 1997; 25: 255-60.

Asling B, Jirholt J, Hammond P, Knutsson M, Walentinsson A, Davidson G, et al. Collagen type III alpha I is a gastro-esophageal reflux disease susceptibility gene and a male risk factor for hiatus hernia. Gut 2009; 58(8): 1063-9.

Kandulski A, Wex T, Monkemuller K, Kuester D, Fry LC, Roessner A, et al. Proteinase-activated receptor-2 in the pathogenesis of gastroesophageal reflux disease. Am J Gastroenterol 2010; 105(9): 1934-43.

Orenstein SR, McGowan JD. Efficacy of conservative therapy as taught in the primary care setting for symptoms suggesting infant gastroesophageal reflux. J Pediatr 2008; 152: 310-4.

Nielsen RG, Bindslev-Jensen C, Kruse-Andersen S, Husby S. Severe gastroesophageal reflux disease and cow milk hypersensitivity in infants and children: disease association and evaluation of a new challenge procedure. J Pediatr Gastroenterol Nutr 2004; 39: 383-91.

Iacono G, Carroccio A, Cavataio F, Montalto G, Kazmierska I, Lorello D, et al. Gastroesophageal reflux and cow's milk allergy in infants: a prospective study. J Allergy Clin Immunol 1996; 97: 822-7.

Orenstein SR, Shalaby TM, Cohn JF. Reflux symptoms in 100 normal infants: diagnostic validity of the infant gastroesophageal reflux questionnaire. Clin Pediatr (Phila) 1996; 35: 607-14.

Hassall E. Talk is cheap, often effective: symptoms in infants often respond to non-pharmacologic measures. J Pediatr 2008; 152: 301-3.

Orenstein SR, Hassall E. Infants and proton pump inhibitors: tribulations, no trials. J Pediatr Gastroenterol Nutr 2007; 45: 395-8.

Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009; 49(4): 498-547.

Omari T. Gastro-oesophageal reflux disease in infants and children: new insights, developments and old chestnuts. J Pediatr Gastroenterol Nutr 2005; 41(Suppl 1): S21-S23.

Vandenplas Y, Hassall E. Mechanisms of gastroesophageal reflux and gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 2002; 35: 119-36.

Wenzl TG. Evaluation of gastroesophageal reflux events in children using multichannel intraluminal electrical impedance. Am J Med 2003; 115(Suppl 3A): 161S-165S.

Wenzl TG, Schenke S, Peschgens T, Silny J, Heimann G, Skopnik H. Association of apnea and nonacid gastroesophageal reflux in infants: investigations with the intraluminal impedance technique. Pediatr Pulmonol 2001; 31: 144-9.

Wenzl TG, Silny J, Schenke S, Peschgens T, Heimann G, Skopnik H. Gastroesophageal reflux and respiratory phenomena in infants: status of the intraluminal impedance technique. J Pediatr Gastroenterol Nutr 1999; 28: 423-8.

Ciofetta G. Gastro-esophageal studies in relationship to respiratory problems. Q J Nucl Med Mol Imaging 2010; 54(4): 372-8.

Dalby K, Nielsen RG, Kruse-Andersen S, Fenger C, Durup J, Husby S. Gastroesophageal reflux disease and eosinophilic esophagitis in infants and children. A study of esophageal pH, multiple intraluminal impedance and endoscopic ultrasound. Scand J Gastroenterol 2010; 45(9): 1029-35.

Forget P, Arends JW. Cow's milk protein allergy and gastro-oesophageal reflux. Eur J Pediatr 1985; 144: 298-300.

Semeniuk J, Kaczmarski M. Gastroesophageal reflux in children and adolescents. Clinical aspects with special respect to food hypersensitivity. Adv Med Sci 2006; 51: 327- 35.

Hill DJ, Cameron DJ, Francis DE, Gonzalez-Andaya AM, Hosking CS. Challenge confirmation of late-onset reactions to extensively hydrolyzed formulas in infants with multiple food protein intolerance. J Allergy Clin Immunol 1995; 96: 386-94.

Isolauri E, Tahvanainen A, Peltola T, Arvola T. Breastfeeding of allergic infants. J Pediatr 1999; 134: 27-32.

Vance GH, Lewis SA, Grimshaw KE, Wood PJ, Briggs RA, Thornton CA, et al. Exposure of the fetus and infant to hens' egg ovalbumin via the placenta and breast milk in relation to maternal intake of dietary egg. Clin Exp Allergy 2005; 35: 1318-26.

Rudolph CD, Mazur LJ, Liptak GS, Baker RD, Boyle JT, Colletti RB. Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 2001; 32(Suppl 2): S1-S31.

Vandenplas Y, Hachimi-Idrissi S, Casteels A, Mahler T, Loeb H. A clinical trial with an anti- regurgitation formula. Eur J Pediatr 1994; 153: 419-23.

Moukarzel AA, Abdelnour H, Akatcherian C. Effects of a prethickened formula on esophageal pH and gastric emptying of infants with GER. J Clin Gastroenterol 2007; 41: 823-9.

Xinias I, Mouane N, Le Luyer B, Spiroglou K, Demertzidou V, Hauser B, et al. Cornstarch thickened formula reduces oesophageal acid exposure time in infants. Dig Liver Dis 2005; 37: 23-7.

Borrelli O, Salvia G, Campanozzi A, Franco MT, Moreira FL, Emiliano M, et al. Use of a new thickened formula for treatment of symptomatic gastrooesophageal reflux in infants. Ital J Gastroenterol Hepatol 1997; 29: 237-42.

Chao HC, Vandenplas Y. Effect of cereal-thickened formula and upright positioning on regurgitation, gastric emptying, and weight gain in infants with regurgitation. Nutrition 2007; 23: 23-8.

Miyazawa R, Tomomasa T, Kaneko H, Arakawa H, Shimizu N, Morikawa A. Effects of pectin liquid on gastroesophageal reflux disease in children with cerebral palsy. BMC Gastroenterol 2008; 8: 11.

Miyazawa R, Tomomasa T, Kaneko H, Arakawa H, Morikawa A. Effect of formula thickened with reduced concentration of locust bean gum on gastroesophageal reflux. Acta Paediatr 2007; 96: 910-4.

Vanderhoof JA, Moran JR, Harris CL, Merkel KL, Orenstein SR. Efficacy of a pre-thickened infant formula: a multicenter, double-blind, randomized, lacebocontrolled parallel group trial in 104 infants with symptomatic gastroesophageal reflux. Clin Pediatr (Phila) 2003; 42: 483-95.

Meyers WF, Herbst JJ. Effectiveness of positioning therapy for gastroesophageal reflux. Pediatrics 1982; 69: 768-72.

Vandenplas Y, Sacre-Smits L. Seventeen-hour continuous esophageal pH monitoring in the newborn: evaluation of the influence of position in asymptomatic and symptomatic babies. J Pediatr Gastroenterol Nutr 1985; 4: 356- 61.

Tobin JM, McCloud P, Cameron DJ. Posture and gastro-oesophageal reflux: a case for left lateral positioning. Arch Dis Child 1997; 76: 254-8.

Corvaglia L, Rotatori R, Ferlini M, Aceti A, Ancora G, Faldella G. The effect of body positioning on gastroesophageal reflux in premature infants: evaluation by combined impedance and pH monitoring. J Pediatr 2007; 151: 591-6, 596 e1.

Bhat RY, Rafferty GF, Hannam S, Greenough A. Acid gastroesophageal reflux in convalescent preterm infants: effect of posture and relationship to apnea. Pediatr Res 2007; 62: 620-3. 58. Oyen N, Markestad T, Skaerven R, Irgens LM, Helweg- Larsen K, Alm B, et al. Combined effects of sleeping position and prenatal risk factors in sudden infant death syndrome: the Nordic Epidemiological SIDS Study. Pediatrics 1997; 100: 613-21.

Skadberg BT, Morild I, Markestad T. Abandoning prone sleeping: effect on the risk of sudden infant death syndrome. J Pediatr 1998; 132: 340-3.

Adams EJ, Chavez GF, Steen D, Shah R, Iyasu S, Krous HF. Changes in the epidemiologic profile of sudden infant death syndrome as rates decline among California infants: 1990-1995. Pediatrics 1998; 102: 1445-51.

Vandenplas Y, De Wolf D, Sacre L. Influence of xanthines on gastroesophageal reflux in infants at risk for sudden infant death syndrome. Pediatrics 1986; 77: 807-10.

Pehl C, Pfeiffer A, Wendl B, Kaess H. The effect of decaffeination of coffee on gastro-oesophageal reflux inpatients with reflux disease. Aliment Pharmacol Ther 1997; 11: 483-6.

Wendl B, Pfeiffer A, Pehl C, Schmidt T, Kaess H. Effect of decaffeination of coffee or tea on gastro-oesophageal reflux. Aliment Pharmacol Ther 1994; 8: 283-7.

Brazer SR, Onken JE, Dalton CB, Smith JW, Schiffman SS. Effect of different coffees on esophageal acid contact time and symptoms in coffee-sensitive subjects. Physiol Behav 1995; 57: 563-7.

Chang CS, Poon SK, Lien HC, Chen GH. The incidence of reflux esophagitis among the Chinese. Am J Gastroenterol 1997; 92: 668-71.

Castiglione F, Emde C, Armstrong D, Bauerfeind P, Schneider C, Stacher G, et al. Oesophageal pH-metry: should meals be standardized? Scand J Gastroenterol 1992; 27: 350-4.

Murphy DW, Castell DO. Chocolate and heartburn: evidence of increased esophageal acid exposure after chocolate ingestion. Am J Gastroenterol 1988; 83: 633-6.

Wright LE, Castell DO. The adverse effect of chocolate on lower esophageal sphincter pressure. Am J Dig Dis 1975; 20: 703-7.

Bartlett DW, Evans DF, Smith BG. Oral regurgitation after reflux provoking meals: a possible cause of dental erosion? J Oral Rehabil 1997; 24: 102-8.

Nebel OT, Fornes MF, Castell DO. Symptomatic gastroesophageal reflux: incidence and precipitating factors. Am J Dig Dis 1976; 21: 953-6.

Allen ML, Mellow MH, Robinson MG, Orr WC. The effect of raw onions on acid reflux and reflux symptoms. Am J Gastroenterol 1990; 85: 377-80.

Bulat R, Fachnie E, Chauhan U, Chen Y, Tougas G. Lack of effect of spearmint on lower oesophageal sphincter function and acid reflux in healthy volunteers. Aliment Pharmacol Ther 1999; 13: 805-12.

Piesman M, Hwang I, Maydonovitch C, Wong RK. Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter? Am J Gastroenterol 2007; 102: 2128-34.

Stanciu C, Bennett JR. Effects of posture on gastrooesophageal reflux. Digestion 1977; 15: 104-9.

Hamilton JW, Boisen RJ, Yamamoto DT, Wagner JL, Reichelderfer M. Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid. Dig Dis Sci 1988; 33: 518-22.

Johnson LF, DeMeester TR. Evaluation of elevation of the head of the bed, bethanechol, and antacid form tablets on gastroesophageal reflux. Dig Dis Sci 1981; 26: 673-80.

Katz LC, Just R, Castell DO. Body position affects recumbent postprandial reflux. J Clin Gastroenterol 1994; 18: 280-3.

Meining A, Classen M. The role of diet and lifestyle measures in the pathogenesis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2000; 95: 2692-7.

Chiba N, De Gara CJ, Wilkinson JM, Hunt RH. Speed of healing and symptom relief in grade II to IV gastroesophageal reflux disease: a meta-analysis. astroenterology 1997; 112: 1798-810.

van Pinxteren B, Numans ME, Bonis PA, Lau J. Shortterm treatment with proton pump inhibitors, H2-receptor antagonists and prokinetics for gastro-oesophageal reflux disease-like symptoms and endoscopy negative reflux disease. Cochrane Database Syst Rev 2006; CD002095.

Khan M, Santana J, Donnellan C, Preston C, Moayyedi P. Medical treatments in the short term management of reflux oesophagitis. Cochrane Database Syst Rev 2007; CD003244.

Canani RB, Cirillo P, Roggero P, Romano C, Malamisura B, Terrin G, et al. Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and communityacquired pneumonia in children. Pediatrics 2006; 117: e817-e820.

Guillet R, Stoll BJ, Cotten CM, Gantz M, McDonald S, Poole WK, et al. Association of H2-blocker therapy and higher incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics 2006; 117: e137-e142.

Saiman L, Ludington E, Dawson JD, Patterson JE, Rangel-Frausto S, Wiblin RT, et al. Risk factors for Candida species colonization of neonatal intensive care unit patients. Pediatr Infect Dis J 2001; 20: 1119-24.

Dial S, Delaney JA, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of communityacquired Clostridium difficile-associated disease. JAMA 2005; 294: 2989-95.

Laheij RJ, Sturkenboom MC, Hassing RJ, Dieleman J, Stricker BH, Jansen JB. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA 2004; 292: 1955-60.

Poets CF. Gastroesophageal reflux: a critical review of its role in preterm infants. Pediatrics 2004; 113: 128-32.

Semeniuk J, Kaczmarski M, Wasilewska J, Nowowiejska B. Is acid gastroesophageal reflux in children with ALTE etiopathogenetic factor of life threatening symptoms? Adv Med Sci 2007; 52: 213-21.

Weiss K, Fattal-Valevski A, Reif S. How to evaluate the child presenting with an apparent life-threatening event? Isr Med Assoc J 2010; 12(3): 154-7.

El-Serag HB, Gilger M, Kuebeler M, Rabeneck L. Extraesophageal associations of gastroesophageal reflux disease in children without neurologic defects. Gastroenterology 2001; 121: 1294-9.

Tasker A, Dettmar PW, Panetti M, Koufman JA, Birchall JP, Pearson JP. Reflux of gastric juice and glue ear in children. Lancet 2002; 359: 493.

Crapko M, Kerschner JE, Syring M, Johnston N. Role of extra-esophageal reflux in chronic otitis media with effusion. Laryngoscope 2007; 117: 1419-23.

Scarupa MD, Mori N, Canning BJ. Gastroesophageal reflux disease in children with asthma: treatment implications. Paediatr Drugs 2005; 7: 177-86.

Cinquetti M, Micelli S, Voltolina C, Zoppi G. The pattern of gastroesophageal reflux in asthmatic children. J Asthma 2002; 39: 135-42.

Rothenberg SS, Bratton D, Larsen G, Deterding R, Milgrom H, Brugman S, et al. Laparoscopic fundoplication to enhance pulmonary function in children with severe reactive airway disease and gastroesophageal reflux disease. Surg Endosc 1997; 11: 1088-90.

Berquist WE, Rachelefsky GS, Kadden M, Siegel SC, Katz RM, Fonkalsrud EW, et al. Gastroesophageal refluxassociated recurrent pneumonia and chronic asthma in children. Pediatrics 1981; 68: 29-35.

Euler AR, Byrne WJ, Ament ME, Fonkalsrud EW, Strobel CT, Siegel SC, et al. Recurrent pulmonary disease in children: a complication of gastroesophageal reflux. Pediatrics 1979; 63: 47-51.

Carre IJ. Pulmonary infections in children with a partial thoracic stomach ('hiatus hernia'). Arch Dis Child 1960; 35: 481-3.

Pace F, Costamagna G, Penagini R, Repici A, Annese V. Review article: endoscopic antireflux procedures - an unfulfilled promise? Aliment Pharmacol Ther 2008; 27: 375- 84.

Bartlett DW, Coward PY, Nikkah C, Wilson RF. The prevalence of tooth wear in a cluster sample of adolescent schoolchildren and its relationship with potential explanatory factors. Br Dent J 1998; 184: 125-9.

O'Sullivan EA, Curzon ME, Roberts GJ, Milla PJ, Stringer MD. Gastroesophageal reflux in children and its relationship to erosion of primary and permanent teeth. Eur J Oral Sci 1998; 106: 765-9.

Ang D, Sifrim D, Tack J. Mechanisms of heartburn. Nat Clin Pract Gastroenterol Hepatol 2008; 5: 383-92.

Hoffman I, Tertychnyy A, Ectors N, De Greef T, Haesendonck N, Tack J. Duodenogastro-esophageal reflux in children with refractory gastro-esophageal reflux disease. J Pediatr 2007; 151: 307-11.

Wu JC, Cheung CM, Wong VW, Sung JJ. Distinct clinical characteristics between patients with nonerosive reflux disease and those with reflux esophagitis. Clin Gastroenterol Hepatol 2007; 5: 690-5.

Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007; 133: 1342-63.

Fass R. Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol 2007; 41: 131-7.

El-Serag HB, Graham DY, Satia JA, Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am J Gastroenterol 2005; 100(6): 1243-50.

Elitsur Y, Dementieva Y, Elitsur R, Rewalt M. Obesity is not a risk factor in children with reflux esophagitis: a retrospective analysis of 738 children. Metab Syndr Relat Disord 2009; 7(3): 211-4.

El-Serag H. Role of obesity in GORD-related disorders. Gut 2008; 57: 281-4.

Gerson LB. A little weight gain, how much gastroesophageal reflux disease? Gastroenterology 2006; 131: 1644-6.

Nurko S, Rosen R. Use of multi-channel intraluminal impedance (MII) in the evaluation of children with respiratory symptoms: a new phenomenon? J Pediatr Gastroenterol Nutr 2005; 41: 166-8.

Nam SY, Choi IJ, Ryu KH, Kim BC, Kim CG, Nam BH. Effect of Helicobacter pylori Infection and Its Eradication on Reflux Esophagitis and Reflux Symptoms Am J Gastroenterol 2010; 105: 2153-62.

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