Determination of the exact prevalence of GER and GERD at any age is virtually impossible because most reflux episodes are asymptomatic, show the absence of specific symptoms, undergo self-treatment and lack medical referral. In normal 3-4-month-old infants, three or four episodes of GER are detectable during 5 min of intermittent fluoro-scopic evaluation,5 and up to 31 ±21 acid reflux episodes are recorded within a 24-h period with pH monitoring.6
The frequency of regurgitation varies according to age. Daily regurgitation is present in 50% of infants younger than 3 months and in more than 66% at 4 months, but only in 5% at 1 year of age.7-9 Complete resolution of regurgitation is frequent and expected, by 10 months in 55%, by 18 months in 60-80% and by 2 years of age in 98%.10 A prospective follow-up of 63 regurgitating infants reported in all subjects, before 12 months, a complete disappearance of symptoms, although accompanied by a significant increase in feeding refusal, duration of meals, parental feeding-related distress and impaired quality of life, even after the disappearance of symptoms.11
About 5-9% of infants have troublesome GERD.6,12 According to parents, heartburn is present in 1.8% of 3-9-year-old healthy children and 3.5% of 1017-year-old adolescents; regurgitation is said to occur in 2.3% and 1.4%, respectively, and 0.5% and 1.9% need anti-acid medication. In self-reports, adolescents complain about heartburn in 5.2% and regurgitation in up to 8.2%, while anti-acids are taken by 2.3% and histamine receptor antagonists (H2RA) by 1.3%, suggesting that symptoms of GER are not rare during childhood and are underreported by the parents or overestimated by the adolescents.13 In a Western population, GERD affected 4-30% of adults14,15 and heartburn and regurgitation resolved within 3-10 years only in 12-33%, regardless of the presence of esophagitis at diagnosis.1,16,17 In the absence of H2RA or proton pump inhibitors (PPI), symptoms improved after 17-22 years in 60% but disappeared in only 12%.18 Despite anti-secretory treatment, a 10-year follow-up of esophagitis showed that over 70% had persisting symptoms and 2% had strictures.19
Reflux esophagitis is reported in 2-5% of the general population.12 Children with GER symptoms present esophagitis in 15 up to 62% of cases, Barrett's esophagus in 0.1-3% and refractory GERD requiring surgery in 6-13%.20-24 In adults undergoing endoscopy, esophagitis is diagnosed in
15 up to 80% of cases.1,17,25,26 The huge differences in incidence are determined by patient recruitment and availability of self-treatment.
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Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.