Gastroesophageal reflux is common in infants and children and should be regarded as pathologic only when it results in symptoms or tissue damage. Prolonged exposure to gastric acid damages the esophagus through increased epithelial cell turnover, impaired barrier function and infiltration of inflammatory cells. Prolonged irritability and feeding problems may cause secondary disruption of parental bonding and family function. The assessment of infants with suspected reflux should include a careful history and physical examination, as well as targeted laboratory investigations to rule out other explanations for symptoms. Monitoring of esophageal pH, esophageal manometry and barium studies may be useful.
Chest radiography is indicated if aspiration is suspected.
Isotopic studies of reflux and gastric emptying and endoscopy may be necessary in selected cases. Up to 80 percent of pregnant women report nausea, and 50 percent experience vomiting. Symptoms resolve in most cases by the end of the first trimester but, in 9 percent of mothers, symptoms continue until at least 20 weeks of gestation. Most antiemetic drugs are not recommended for use during pregnancy because of concerns about safety, and clinical trials are nearly impossible because of ethical and other concerns. A combination of doxylamine and pyridoxine has been studied in large numbers of patients and has been shown to be effective without increased risk of teratogenicity.