Regurgitation is the most prominent presenting symptom of reflux disease in young children. This is in contrast with older children and adults, for whom heartburn is the most common symptom.
Symptoms of infantile reflux esophagitis. A, Crying and irritability, commonly believed to be a sensitive indicator of esophagitis in infants, occur in most, but not all, such infants with esophagitis, but also in many infants without esophagitis. B, Arching (torso hyperextension) occurs in infants with esophagitis in a proportion similar to that of those with crying and irritability, but is far more specifically diagnostic for esophagitis than crying. C, Refusing feedings even when hungry occurs in slightly less than half of infants with esophagitis but occurs so infrequently in infants without esophagitis that it is fairly specific. D, Gagging and choking on feedings also occurs somewhat more frequently in infants with esophagitis than those without, although not significantly so [26]
Endoscopic view of normal esophageal mucosa and erosive esophagitis in two children. A, The smooth pink mucosa of the normal esophagus contrasts with B, The eroded, bleeding mucosa of the esophagus with severe esophagitis. Histologic esophagitis may be present even in endoscopically normal-appearing mucosa, and subtle changes including erythema, formerly considered to represent mild endoscopic esophagitis, have been found to be nonspecific, at least in children [69]. Histologic samples should be taken during endoscopic evaluation to increase the sensitivity and specificity of the findings. (From Orenstein [55]