Review paper
Therapeutic problems associated with gastroesophageal or duodenal reflux in pediatric patients

Gastro-esophageal reflux (GER) is considered a common physiological phenomenon in children and adolescents. Therewith associated most prevalent clinical manifestations are regurgitations in infants and toddlers and symptomatic heartburn in older children. Frequent repetitive episodes of backward flow of either gastric acid or duodenal content, or both, into the esophagus may lead to the development of oesophagitis and gastro-esophageal reflux disease (GERD). Current practice management guidelines in this condition are usually confined to the pharmacological inhibition of gastric secretion using inhibitors of proton pump (IPP), however, such treatment is not always effective. The authors of the present review discuss a possible role of some etiological factors in the development of GER and GERD, highlight the need of a complex therapy and emphasize the importance of potential pathogenic mechanisms that may influence therapeutic outcome in the disease. These are: the individual ontogenetic deterioration of anti-reflux barrier (both anatomical and functional) occurring in the primary GER and maturating with age, food allergy producing increased risk of the secondary GER, the need of introducing new drugs, other than IPP, and changes of lifestyle or nutritional habits in pediatric patients with GER.