Regurgitation is defined as passage of refluxed gastric contents into the oral pharynx and the mouth and is accompanied by gastric content drooling out of the mouth. Spitting-up is synonymous with regurgitation. Vomiting is defined as expulsion of the refluxed gastric contents from the mouth.3,4 Only a minority of reflux episodes is accompanied by regurgitation or vomiting. Rumination is characterized by the voluntary, habitual regurgitation of recently ingested food that is subsequently spitted up or re-swallowed.

Sometimes GER is a normal esophageal function, serving a protective role, e.g. during meals, or in the immediate postprandial period; if the stomach is overdistended, GER serves to decompress it.

Regurgitation may be physiological in healthy, thriving, happy infants. Primary GER results from a primary disorder of function of the upper gastrointestinal tract. In secondary GER, reflux results from dysmotility occurring in systemic disorders such as neurological impairment or systemic sclerosis. It may also result from mechanical factors at play in chronic lung disease or upper airway obstruction, as in chronic tonsillitis. Other causes include systemic or local infections (urinary tract infection, gastroenteritis), food allergy, metabolic disorders, intracranial hypertension and medications such as chemotherapy. In some cases, secondary reflux results from stimulation of the vomiting center by afferent impulses from circulating bacterial toxins, or stimulation from sites such as the eye, olfactory epithelium, labyrinths, pharynx, gastrointestinal and urinary tracts, and testes.3,4 These stimuli usually cause vomiting. The symptoms and signs of primary and secondary reflux are similar, but a distinction is conceptually helpful in determining a therapeutic approach. Secondary GER is not discussed further.

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