الفهرس 
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Abstract
Gastro-esophageal reflux is a frequently experienced physiological condition, with involuntary retrograde passage of the gastric contents into the esophagus. It affects 75-80% of infants less than 2 months old and usually resolves spontaneously.
When complicated or affecting the quality of life, the condition is called gastro-esophageal reflux disease.
Gastro-esophageal reflux is classified into primary GER or secondary GER (secondary to neurological, genetic conditions or anatomical anomalies of the GI tract).
It is suspected when there are unexplained recurrent attacks of vomiting and regurgitation, repeated respiratory tract infections, weight loss and failure to thrive.
Upper GI contrast study with trendlenberg position and gastric emptying time is usually the initial imaging modality (to exclude anatomical abnormalities and confirmation of presence of reflux in a percentage of patients). Electrophysiological studies (pH metry and MII) are the imaging modalities of choice to confirm the diagnosis and to correlate the symptoms with the low pH level recorded in the lower part of the esophagus. However, both of them require special devices and electrodes and are not always available.
GERD in neonates and infants less than 3 months old can be treated whether medically or surgically, but no clear indication have been explained nor the outcomes. That’s why this study was conducted, aiming to assess the outcomes of medical and surgical treatment with identification of some indications and timing of surgical intervention.
The study followed up 27 patients, according to some inclusion and exclusion criteria. 20 patients were managed medically and 7 patients required surgical antireflux procedure in the form of Nissen fundoplication and feeding gastrostomy.
Results were studied, analyzed and revealed the proportional relation between the duration of medical treatment and complications (patients who were treated medically for more than 35 days developed complications, sometimes serious, up to mortality).
Medical treatment failed and surgical antireflux procedure was usually needed in preterm patients (GA less than 32 weeks)
Limitations to the study were the small number of patients included as well as unavailability of more precise diagnostic procedures (in our hospital) to confirm the relations between the acidic reflux and the symptoms and whether it is the actual cause or only an association