ABSTRACT
Upper gastrointestinal studies may detect anatomical abnormalities but are insensitive and non-specific for the diagnosis of gastro-oesophageal reflux disease (GORD) and H. pylori-associated mucosal injury. Oesophageal manometry studies the contractile activity of the oesophagus and the upper and lower sphincters. It is important in research of GORD, but is of little value as a diagnostic tool. In children who are continuously fed, conventional pH studies may underestimate or miss GOR because of the neutralising effect of the continuous milk feed. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition published guidelines in 1993, citing cisapride as a first-line treatment for GOR/GORD. Both the Thal and Boix-Ochoa techniques allow a physiological degree of GOR, avoid the gastric bloat problem and even permit vomiting. Enteral feeding is via gastrostomy. The most commonly performed operation for GOR is the laparoscopic Nissen fundoplication. The transoral incisionless fundoplication (TIF) with EsophyX is heralded as the endoluminal alternative to conventional fundoplication.
