Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux (GER) is a common event in the first year of life and it mainly causes regurgitation and/or vomiting episodes in an otherwise thriving infant. Reflux is the involuntary passage of gastric contents into the esophagus and occurs in the majority of infants.
Regurgitation, where gastric contents reflux into the oral cavity, is the most common presentation and occurs at least once a day in a third of infants at 4 month of age.

Generally, parents poorly tolerate this clinical condition. It is responsible for parental anxiety and consequently for multiple visits to the pediatrician. Uncomplicated GER in infants is considered as a self-limited process treated with thickened feeds, positional treatment and parental reassurance without performing any further investigation.

GER becomes GERD when associated with complications and additional manifestations:


Gastroesophageal reflux disease (GERD) is clearly considered a pathological condition characterized by regurgitation and/or vomiting associated with poor weight gain, esophagitis, respiratory symptoms, signs and symptoms of distressed behaviour and other complications.


An accurate diagnostic approach followed by appropriate therapeutic strategies is mandatory when facing an infant with complicated GER.

The goal of GERD therapy is to remove the cause of GER or, otherwise, to resolve symptoms and to prevent the eventual harmful complications. Anyway, it aims at improving the quality of life of young patients.

It has been shown that GERD affects 1:300 infants in the first year of life, but after this period very little is known about its prevalence. GERD is less frequent in infancy, but it does not resolve spontaneously.

Certain indicators are strongly suggestive of food allergic GERD:

• other symptoms typical of allergy eg. diarrhea or eczema;
• allergic symptoms in first degree relatives;
• appearance of symptoms upon formula change/weaning;
• lack of response to acid suppression therapy.

A common association with Cow Milk Allergy is often observed, and this is thought to relate to immaturity of the anti-reflux barrier. On the basis of studies using cow's milk elimination and challenge, it is clear that CMA is associated with GERD in a subset of between 16-42% patients.