PHYSIOLOGICAL GASTROESOPHAGEAL REFLUX AND GASTROESOPHAGEAL REFLUX DISEASE: A SYNTHESIS OF EVIDENCE

Abstract

Physiological gastroesophageal reflux (GER) is common in infants due to the immaturity of the lower esophageal sphincter (LES) and is generally benign, self-limiting, and spontaneously resolves by two years of age. In contrast, gastroesophageal reflux disease (GERD) is characterized by persistent symptoms that affect quality of life and may lead to complications; it is frequently associated with irritability, excessive crying, poor weight gain, and sleep disturbances. Enabling healthcare professionals to distinguish GERD from physiological GER, understand diagnostic methods, and choose the most appropriate treatment is essential for successful case management. This study aimed to analyze therapeutic approaches in the management of GERD in infants. A literature review was conducted in the SciELO, Medline, Lilacs, Google Scholar, and PubMed databases, including articles published from 2020 onward addressing the definition, diagnosis, and management of GER. Physiological GER is benign and self-limiting, with spontaneous resolution in up to 95% of cases by two years of age, whereas GERD presents with persistent symptoms (irritability, feeding refusal, poor weight gain) and respiratory/digestive complications. Diagnosis is essentially clinical, supported by validated questionnaires, with invasive tests reserved for refractory cases. Non‑pharmacological measures (positioning, dietary modifications, cow's milk protein exclusion) constitute first‑line therapy. Proton pump inhibitors are an option for refractory cases but require caution due to adverse effects and low adherence to guidelines, while Nissen fundoplication is reserved for severe cases. Based on the analyzed articles, it is concluded that medical history and physical examination are essential to distinguish physiological from pathological reflux. Furthermore, implementing non‑pharmacological measures—such as specific positioning and dietary changes—is beneficial as initial treatment, while more severe cases may require pharmacological interventions prescribed by a pediatric gastroenterologist.