Diagnosis and treatment of gastro-oesophageal reflux.

Gastro-oesophageal reflux (GOR) is defined as the involuntary passage of gastric contents into the oesophagus, and is a common cause of morbidity in childhood. GOR is an occasional physiological event in normal adults and children,1 2 but becomes pathological when its intensity or frequency increases or when complications arise (for example, oesophagitis, failure to thrive). GOR may be primary (due to anatomical or physiological abnormalities) or secondary to other diseases such as urinary tract infection, metabolic disorders, food allergy, etc (see table 1). The increasing availability of lower oesophageal pH monitoring, paediatric endoscopic skills, and newer more effective pharmacological agents has led to a greater awareness of the range of symptoms attributable to gastro-oesophageal reflux disease (GORD), and the need for a structured approach to diagnosis and management.