Importance: Rarely have the best methods of diagnosis or the treatment of a disease engendered more controversy than gastroesophageal reflux (GER), a highly prevalent condition in infants.
Objective: To discuss the latest controversies in the diagnosis and treatment of GER in infants.
Evidence review: All articles related to the diagnosis and treatment of GER were reviewed and, whenever possible, literature about infants was weighted with greater importance than literature about older children and adults.
Findings: Although as many as 60% of infants have signs of GER, the role of GER in causing disease is difficult to elucidate. Despite new diagnostic tools to detect acid and nonacid reflux, our understanding of the relationship between reflux events and symptoms is complex. Furthermore, acid suppression, the mainstay of therapy for GER, increases the burden of nonacid reflux, which is already much higher in infants than in older children and which may worsen symptoms. Therefore, more conservative therapies are recommended for symptomatic infants.
Conclusions and relevance: Although GER is a common reason for visits to primary care providers and specialists, few data suggest that GER results in many of the symptoms to which it has been attributed. A strong shift away from acid-suppression therapy in infants has occurred because of the adverse effects, lack of efficacy, and increase of nonacid reflux burden relative to acid burden. Nonpharmacologic measures should be used whenever possible because most infant GER will resolve without intervention.