The natural course of gastro-oesophageal reflux.

Gastro-oesophageal reflux disease is a common phenomenon usually consistent with a benign prognosis. But alarm symptoms and complications occur at any age, and may be difficult to recognize clinically although requiring prompt and adequate intervention. Many unsettled issues in gastro-oesophageal reflux (disease) are encountered in its natural course and clinical presentation. Severity of reflux is much more related to complications than to the amount of reflux. Current medical reflux treatment with H2-receptor antagonists and preferably with proton pump inhibitors is efficient in controlling symptoms and healing oesophagitis. Whether early treatment of mild reflux significantly changes the incidence or severity of symptoms and complications in adulthood is uncertain. Atopic disease is now recognized to cause reflux-like symptoms. Paediatricians should adequately consider the impact on the quality of life of repetitive regurgitation. Further research is needed to define more clearly how many, which and why some children with reflux disease progress to persisting chronic disease and others do not.