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December 27, 2000

The Spectrum of Pediatric Gastroesophageal Reflux

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(24):3125. doi:10.1001/jama.284.24.3123

To the Editor: Ms Hu and colleagues1 sought to identify the genetic map for pediatric gastroesophageal reflux (GER). However, the authors do not report diagnostic criteria for GER, and therefore we are concerned about the uniformity of their sample.

Children with chronic vomiting, spitting up, dysphagia, and food refusal are commonly diagnosed with GER and are treated with acid suppression. Alternatively, these symptoms may have other causes such as anatomical malformations, food allergies, functional bowel diseases, or metabolic disorders. Clinical criteria used to make an initial diagnosis of GER can be subjective, but when symptoms are refractory to medical management, patients will often undergo evaluation including esophagogastroduodenoscopy with biopsy. One emerging cause of such refractory symptoms is eosinophilic esophagitis (EE), which has been reported in at least 81 children in 4 different academic institutions.2-5 The affected squamous epithelium contains a large number of intraepithelial eosinophils, despite at least 2 months of acid suppression.2 Treatment with fundoplication is not therapeutic, but corticosteroids or an elemental diet provide effective symptom control and improvement of esophageal histology.3,4 To date, the incidence, etiology, and long-term consequences of EE are not well defined.