Management of esophagitis in children

PPI: proton pump inhibitor; GERD: gastroesophageal reflux disease; EoE: eosinophilic esophagitis; MII: multichannel intraluminal impedance; GER: gastroesophageal reflux.
* In patients with endoscopically documented esophagitis on chronic PPI therapy, further evaluation depends on the suspicion for disease other than GERD. Patients with neurologic impairment are predisposed to GERD and may not require further work-up. For patients without neurologic impairment, work-up might include esophageal pH-MII monitoring or further evaluation for EoE (allergy evaluation, therapeutic trial of dietary and/or pharmacologic treatment).
¶ Antireflux surgery appears to be successful in controlling reflux and is sometimes indicated for control of GER in many patients with debilitating GERD that is refractory to medical management. However, surgery should be approached with caution, especially in neurologically- mpaired children, and other causes of the symptoms and signs should be excluded. Estimates of efficacy and failure rates of surgery vary widely, and complications are common.