Pediatric emergency medicine trisk 2096 2096
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number of ED visits annually. GER complications or complaints can be
esophageal or extraesophageal. Esophageal complaints include vomiting, poor
weight gain, abdominal pain, or retrosternal pain. Extraesophageal complaints
may include cough, recurrent pneumonia, laryngitis, dental erosions, and
wheezing in infancy. There is no strong evidence, however, to suggest that
treating GERD will improve reactive airway disease or recurrent pneumonia.
The degree to which GER contributes to any extraesophageal complaint can
be difficult to associate. Importantly, there are certain “red flag” complaints
that are not associated with GERD and should raise concerns for an alternative
diagnosis ( Table 91.7 ). There are certain populations that seem to be at
higher risk for developing complications of GER, including those patients
with severe neurologic impairment, underlying severe pulmonary disease
(cystic fibrosis, bronchopulmonary dysplasia), premature infants, repaired
esophageal achalasia or atresia, and patients with lung transplants. GERD
complaints also vary by age group. GERD in infants seems to peak at around
50% by 4 months of age, whereas only 5% to 10% of patients have clinically
significant GERD at 1 year. In general, GERD is a clinical diagnosis and no
additional testing is necessary; however, additional diagnostic testing
modalities are available in the right clinical context and include pH and
impedance probe monitoring and endoscopy.
