Diagnosis of Gastroesophageal Reflux Disease

  • Yvan VandenplasEmail author


The diagnosis of gastroesophageal reflux disease (GERD) remains a challenge. The symptoms and manifestations caused by GERD vary from nonerosive reflux disease over Barrett’s esophagus to chronic respiratory disease. As a consequence, it is clear that not one investigation technique will provide an answer in all situations. Although many diagnostic techniques are available, most of them are not needed to diagnose GERD. Upper gastrointestinal tract endoscopy with biopsies is indicated to exclude differential diagnoses, but not to diagnose GERD. Multiple intraluminal impedance (MII) has been extensively evaluated in recent years, but will be discussed more in detail in a different chapter.


Acid reflux Barium meal (Upper) endoscopy Extra-esophageal symptoms Gastroesophageal reflux (disease) (Multiple intraluminal) Impedance pH meter pH monitoring Scintiscanning Symptom association Ultrasound Vomiting Weakly acid reflux 


  1. 1.
    Vandenplas Y, Rudolph CD, Di Lorenzo C, North American Society for Pediatric Gastroenterology Hepatology and Nutrition, European Society for Pediatric Gastroenterology Hepatology and Nutrition, 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;49:498–547.CrossRefPubMedGoogle Scholar
  2. 2.
    Lightdale JR, Gremse DA, Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013;131:e1684–95.CrossRefPubMedGoogle Scholar
  3. 3.
    von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain. 2007;127:140–50.CrossRefGoogle Scholar
  4. 4.
    Stanford EA, Chambers CT, Craig KD. The role of developmental factors in predicting young children's use of a self-report scale for pain. Pain. 2006;120:16–23.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Orenstein SR, Shalaby TM, Cohn JF. Reflux symptoms in 100 normal infants: diagnostic validity of the infant gastroesophageal reflux questionnaire. Clin Pediatr (Philadelphia). 1996;35:607–14.CrossRefGoogle Scholar
  6. 6.
    Kleinman L, Rothman M, Strauss R, Orenstein SR, Nelson S, Vandenplas Y, Cucchiara S, Revicki DA. The infant gastroesophageal reflux questionnaire revised: development and validation as an evaluative instrument. Clin Gastroenterol Hepatol. 2006;4:588–96.CrossRefPubMedGoogle Scholar
  7. 7.
    Aggarwal S, Mittal SK, Kalra KK, et al. Infant gastroesophageal reflux disease score: reproducibility and validity in a developing country. Trop Gastroenterol. 2004;25:96–8.PubMedGoogle Scholar
  8. 8.
    Salvatore S, Hauser B, Vandemaele K, et al. Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology? J Pediatr Gastroenterol Nutr. 2005;40:210–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Orenstein SR, Hassall E, Furmaga-Jablonska W, Atkinson S, Raanan M. Multicenter, double-blind, randomized, placebo-controlled trial assessing efficacy & safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. J Pediatr. 2009;154:514.e4–20.e4.CrossRefGoogle Scholar
  10. 10.
    Winter H, Gunasekaran T, Tolia V, Gottrand F, Barker PN, Illueca M. Esomeprazole for the treatment of GERD in infants ages 1-11 months. J Pediatr Gastroenterol Nutr. 2012;55:14–20.CrossRefPubMedGoogle Scholar
  11. 11.
    Deal L, Gold BD, Gremse DA, et al. Age-specific questionnaires distinguish GERD symptom frequency and severity in infants and young children: development and initial validation. J Pediatr Gastroenterol Nutr. 2005;41:178–85.CrossRefPubMedGoogle Scholar
  12. 12.
    Orenstein SR, Kocoshis SA, Orenstein DM, Proujansky R. Stridor and gastroesophageal reflux: diagnostic use of intraluminal esophageal acid perfusion (Bernstein test). Pediatr Pulmonol. 1987;3:420–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Vandenplas Y, Badriul H, Verghote M, et al. Glass and antimony electrodes for oesophageal pH monitoring in distressed infants: how different are they? Eur J Gastroenterol Hepatol. 2004;16:1325–30.CrossRefPubMedGoogle Scholar
  14. 14.
    Hemmink GJ, Weusten BL, Oors J, et al. Ambulatory oesophageal pH monitoring: a comparison between antimony, ISFET, and glass pH electrodes. Eur J Gastroenterol Hepatol. 2010;22:572–6.CrossRefPubMedGoogle Scholar
  15. 15.
    Vandenplas Y, Sacre-Smits L. Continuous 24-hour esophageal pH monitoring in 285 asymptomatic infants 0–15 months old. J Pediatr Gastroenterol Nutr. 1987;6:220–4.CrossRefPubMedGoogle Scholar
  16. 16.
    Vandenplas Y, Goyvaerts H, Helven R, Sacre L. Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome. Pediatrics. 1991;88:834–40.PubMedGoogle Scholar
  17. 17.
    Vandenplas Y, Lepoudre R, Helven R. Dependability of esophageal pH-monitoring data in infants on cutoff limits: the oscillatory index. J Pediatr Gastroenterol Nutr. 1990;11:304–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Vandenplas Y, Franckx-Goossens A, Pipeleers-Marichal M, Derde MP, Sacré-Smits L. Area under pH 4: advantages of a new parameter in the interpretation of esophageal pH monitoring data in infants. J Pediatr Gastroenterol Nutr. 1989;9:34–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Ummarino D, Vandermeulen L, Roosens B, et al. Gastroesophageal reflux evaluation in patients affected by chronic cough: Restech versus multichannel intraluminal impedance/pH metry. Laryngoscope. 2013;123:980–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Chiou E, Rosen R, Nurko S. Effect of different pH criteria on dual-sensor pH monitoring in the evaluation of supraesophageal gastric reflux in children. J Pediatr Gastroenterol Nutr. 2011;52:399–403.CrossRefPubMedGoogle Scholar
  21. 21.
    Vailati C, Mazzoleni G, Bondi S, Bussi M, Testoni PA, Passaretti S. Oropharyngeal pH monitoring for laryngopharyngeal reflux: is it a reliable test before therapy? J Voice. 2013;27:84–9.CrossRefPubMedGoogle Scholar
  22. 22.
    Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, Burks AW, Chehade M, Collins MH, Dellon ES, Dohil R, Falk GW, Gonsalves N, Gupta SK, Katzka DA, Lucendo AJ, Markowitz JE, Noel RJ, Odze RD, Putnam PE, Richter JE, Romero Y, Ruchelli E, Sampson HA, Schoepfer A, Shaheen NJ, Sicherer SH, Spechler S, Spergel JM, Straumann A, Wershil BK, Rothenberg ME, Aceves SS. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128:3–20.CrossRefPubMedGoogle Scholar
  23. 23.
    Macharia EW. Comparison of upper gastrointestinal contrast studies and pH/impedance tests for the diagnosis of childhood gastro-oesophageal reflux. Pediatr Radiol. 2012;42:946–51.CrossRefPubMedGoogle Scholar
  24. 24.
    Sager S, Halac M, Selcuk N, Dogan I, Kabasakal L, Onsel C, Uslu I. Temporal relationship between gastroesophageal reflux and rate of gastric emptying in children. Nucl Med Commun. 2010;31:1059–62.PubMedGoogle Scholar
  25. 25.
    Ravelli AM, Panarotto MB, Verdoni L, Consolati V, Bolognini S. Pulmonary aspiration shown by scintigraphy in gastroesophageal reflux-related respiratory disease. Chest. 2006;130:1520–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Jang HS, Lee JS, Lim GY, Choi BG, Choi GH, Park SH. Correlation of color Doppler sonographic findings with pH measurements in gastroesophageal reflux in children. J Clin Ultrasound. 2001;29(4):212–7.CrossRefPubMedGoogle Scholar
  27. 27.
    Talley NJ, Armstrong D, Junghard O, Wiklund I. Predictors of treatment response in patients with non-erosive reflux disease. Aliment Pharmacol Ther. 2006;24:371–6.CrossRefPubMedGoogle Scholar
  28. 28.
    Savino A, Cecamore C, Matronola MF, Verrotti A, Mohn A, Chiarelli F, Pelliccia P. US in the diagnosis of gastroesophageal reflux in children. Pediatr Radiol. 2012;42:515–24.CrossRefPubMedGoogle Scholar
  29. 29.
    Saber H, Ghanei M. Extra-esophageal manifestations of gastroesophageal reflux disease: controversies between epidemiology and clinic. Open Respir Med J. 2012;6:121–6.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Farhath S, He Z, Saslow J, Soundar S, Amendolia B, Bhat V, Pyon K, Stahl G, Mehta D, Aghai ZH. Detection of pepsin in mouth swab: correlation with clinical gastroesophageal reflux in preterm infants. J Matern Fetal Neonatal Med. 2013;26:819–24.CrossRefPubMedGoogle Scholar
  31. 31.
    James ME, Ewer AK. Acid oro-pharyngeal secretions can predict gastro-oesophageal reflux in preterm infants. Eur J Pediatr. 1999;158:371–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Gold BD, Gunasekaran T, Tolia V, Wetzler G, Conter H, Traxler B, Illueca M. Safety and symptom improvement with esomeprazole in adolescents with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2007;45:520–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Tolia V, Bishop PR, Tsou VM, Gremse D, Soffer EF, Comer GM. Multicenter, randomized, double-blind study comparing 10, 20 and 40 mg pantoprazole in children (5–11 years) with symptomatic gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2006;42:384–91.CrossRefPubMedGoogle Scholar
  34. 34.
    Kahrilas PJ, Falk GW, Johnson DA, Schmitt C, Collins DW, Whipple J, D’Amico D, Hamelin B, Joelsson B. Esomeprazole improves healing and symptom resolution as compared with omeprazole in reflux oesophagitis patients: a randomized controlled trial. The Esomeprazole Study Investigators. Aliment Pharmacol Ther. 2000;14:1249–58.CrossRefPubMedGoogle Scholar
  35. 35.
    Richter JE, Kahrilas PJ, Johanson J, Maton P, Breiter JR, Hwang C, Marino V, Hamelin B, Levine JG. Efficacy and safety of esomeprazole compared with omeprazole in GERD patients with erosive esophagitis: a randomized controlled trial. Am J Gastroenterol. 2001;96:656–65.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of PediatricsUZ Brussel, Free University of BrusselsBrusselsBelgium

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