Gastro-oesophageal reflux: Pathogenesis, symptoms, diagnostic and therapeutic management

Gastro-oesophageal reflux (GOR) is very frequent in the first year of life; indeed, it has been reported that approximately 50% of babies up to 3 month regurgitate at least once per day [1]. GOR might be elicited by several, physiological mechanisms: the supine position, which promotes the rise of gastric content into oesophagus; the relatively abundant milk intakes; the immaturity of oesophageal motility, which entails a poor clearance of refluxate especially in the preterm population [2]. GOR is mainly due to the occurrence of transient lower oesophageal sphincter relaxations (TLOSRs), unaccompanied by swallowing, that enhance the passage of gastric content in the oesophageal lumen [3], whereas in a few cases GOR follows a sudden increase of intra-abdominal pressure, not supported by a consensual augment of lower oesophageal sphincter (LOS) pressure . In the majority of infants experiencing frequent regurgitations without clinical complications (the so-called “happy spitters”), GOR can be considered a physiological and not harmful phenomenon. Nevertheless, in moderate to severe cases, such complications as feeding problems, failure to thrive, esophagitis, odynophagia or lung aspiration [4] are commonly observed, thereby outlining the profile of gastro-oesophageal reflux disease (GORD). Other atypical symptoms of GORD are bronchospasm, laryngitis, sinusitis, otitis, unexplained irritability and, in a few number of infants, spastic torticollis and dystonic body movements, which characterize the “Sandifer syndrome”. If pathological GOR is suspected, deepen diagnostic investiga- tions should be assessed to evaluate GOR severity and features, as the prevalence of acid or non-acid GOR entails different clinical and therapeutic implications [2].