Long-term follow-up of infants with pathological gastroesophageal reflux

Between 1981 and 1984 330 infants with suspected gastroesophageal reflux (GER) were investigated by combined esophageal manometry and pH-monitoring. GER of 283 patients with a manometric reflux time more than 1% was classified as pathologic. After one year of conservative therapy a follow-up-study mainly by 24-hour-pH-monitoring could be performed in 108 patients. Two thirds (76 out of 108) still showed a pathological GER. In the age of about two years follow-up-investigation in 41 patients showed in one third of them (13 out of 41) a pathological GER. 5.4% of all investigated children (18 out of 330) hat to be operated because of complicated GER. Follow-up has been performed in 24 children over five years with manometry and/or pH-monitoring and/or barium swallow and/or endoscopy with biopsy. After one year of conservative therapy more than two thirds of them (19 out of 24), after two years one third (eight out of 24) showed a pathological GER. In a few cases (four out of 24) the pathological GER disappeared spontaneously in the age of four to five years. In the age of 1.5 to three years six children had to be operated because of complicated GER. We conclude from this study that a spontaneous healing of pathological GER occurs in about two thirds of the patients older than one year. In about 8% (two out of 24) a pathological GER persists over the fifth year of life representing a permanent risk of GER complications.