Gastroesophageal reflux (GER) is very common in children due to immaturity of the antireflux barrier. In critically ill patients there is also a high incidence due to a partial or complete loss of pressure of the lower esophageal sphincter though other factors, such as the use of nasogastric tubes, treatment with adrenergic agonists, bronchodilators, or opiates and mechanical ventilation, can further increase the risk of GER. Vomiting and regurgitation are the most common manifestations in infants and are considered pathological when they have repercussions on the nutritional status. In critically ill children, damage to the esophageal mucosa predisposes to digestive tract hemorrhage and nosocomial pneumonia secondary to repeated microaspiration. GER is mainly alkaline in children, as is also the case in critically ill pediatric patients. pH-metry combined with multichannel intraluminal impedance is therefore the technique of choice for diagnosis. The proton pump inhibitors are the drugs of choice for the treatment of GER because they have a greater effect, longer duration of action, and a good safety profile. 1. Introduction Gastroesophageal reflux (GER) occurs when gastric contents pass through the lower esophageal sphincter (LES) into the esophagus [1]. Under normal conditions, reflux is prevented by correct function of the gastroesophageal junction, also known as the antireflux barrier. 2. Incidence GER is very common in children due to immaturity of the antireflux barrier. Clinical manifestations usually begin at 2 to 3 months of age [2] and are characterized by the regurgitation of milk, mostly in the postprandial period; however, the child’s growth and development are not affected [2]. The frequency of GER is higher in infants than in older children and adults, with prevalences of up to 85% [3]. The male-to-female ratio is from 1.6 to 1. The higher prevalence is due to immaturity of the esophagus and stomach in infants and because most of the diet is ingested in liquid form [4]. Other risk groups include children with cerebral palsy, children requiring surgery to correct esophageal atresia, and patients with hiatus hernia [2]. The administration of certain drugs that can relax the LES will also predispose to GER. These drugs include the anticholinergics, calcium-channel blockers, benzodiazepines, and dopamine [5]. Additional risk factors that have been identified in adults are alcohol consumption, smoking, connective tissue diseases (particularly scleroderma) [6], and chronic obstructive pulmonary disease [7]. 3. Pathophysiology The antireflux
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