Complaints commonly center around epigastric abdominal pain, vomiting, heartburn, and regurgitation. Hematemesis can also occur.

Currently, upper endoscopy with biopsy is the gold standard for the diagnosis of H. pylori infection. Serum antibodies to H. pylori can be detected; however, this test carries a poor specificity because previously infected individuals may remain serum antibody positive, despite lacking clinical evidence of gastritis. Stool H. pylori antigen testing and the urea breath test may supplant the need for upper endoscopy.

Gastroesophageal reflux is the movement of stomach contents into the esophagus, past the lower esophageal sphincter. It is commonly caused by a delay in gastric emptying or transient relaxation of the lower esophageal sphincter.

Many newborns manifest inconsequential regurgitation after meals; this condition typically resolves by 3 to 6 months of age. In the usual presentation of GE reflux, frequent small mouthfuls of stomach contents are regurgitated in an effortless manner. No active emesis is observed. This phenomenon is frequently referred to as “spitting” or “wet burps.” Newborns with more severe reflux may also exhibit arching episodes (Sandifer syndrome) and irritability associated with feeding. Symptoms in older children include heartburn, chest or epigastric pain, dysphagia, water brash (a sour taste in mouth), or globus (the sensation that something is stuck in the throat).

In more pathologic cases, GERD is associated with more severe symptoms, such as weight loss, recurrent wheezing or coughing, recurrent pneumonia from aspiration, or apparent life-threatening episodes. Many times, concomitant esophagitis (manifested as irritability in infants) can occur. In many cases, no obvious spitting is seen, but studies clearly document gastroesophageal reflux.

Recently, an increasing number of children with symptoms of GERD were identified with EE. The presentation of EE is often very similar to GERD; however, these patients fail to respond adequately to antireflux medications. The disease is caused by food allergy and characterized by a severe isolated histologic esophageal eosinophilia despite aggressive acid suppression therapy.

Complications associated with GERD include hematemesis, aspiration, and failure to thrive.

GERD is primarily a clinical diagnosis, but several diagnostic tests can aid in the evaluation:

EE is an allergic (autoimmune) esophageal disorder based on a clinicopathologic diagnosis that includes the presence of a large number of tissue eosinophils isolated from the esophagus.

In children, EE presents with symptoms similar to those seen with GERD. These symptoms include vomiting, regurgitation, epigastric pain, poor feeding, and failure to thrive. Older children commonly manifest symptoms of heartburn, water brash, nausea, and dysphagia. It is not uncommon for adolescents to complain of difficulty in swallowing solid foods or have intermittent food impactions.