Pediatric gastroesophageal reflux disease: Current diagnosis and management

Pediatric gastroesophageal reflux disease (GERD) is a disorder difficult to diagnose and to treat. Due to the current definition of GERD, i.e. gastroesophageal reflux (GER) causing bothersome symptoms and/or complications, diagnosis is subject to broad interpretation. This thesis consists of studies elucidating the diagnostic accuracy of different diagnostic tools, and gathers new insights in commonly used tests in pediatric GERD. Furthermore, it describes the efficacy and safety of commonly used pharmaceutical agents in this patient group.
It shows that the accuracy of various diagnostic tests remains unclear in children suspected of GERD. It demonstrates the development of a new scoring system that measures laryngeal aberrations, thought to be caused by GER. Proton pump inhibitors (PPIs) were found not to be effective in reducing GERD symptoms in infants. Although PPIs seem to be well tolerated during short-term use, evidence supporting the safety of PPIs in the longer term is lacking. Last, by performing gastric juice analysis it is shown that bile salts, which are potentially harmful to the esophageal and bronchial mucosa, are present in higher levels with prolonged use of PPIs, which in turn could lead to persistent gastroesophageal reflux symptoms.