D in children may cause repeated vomiting, effortless spitting up, coughing, and ot her respiratory problems, such as wheezing. Inconsolable crying, refusing food, crying for food and t 59li hen pulling off te lihe bottle or breast only to cry for it again, failure to gain ade quate weight, bad breath, and belching or burping are al 59li so common. Children may have one sympt om or many; no single symptom is universal in al 59li l children with GERD. Of the estimated 4 million babies born in the US each 6w59li year, up f them may have diffic ulties e 6w59li with reflux in the fi 59li rst few months of their lives, known as 'spitting theo ry for this is thee li "fourth trimester theory" which notes most animals are born with significan t mobility, but humans are rel 59li atively helple liess at bir 59li th,e li and suggests there may have once bee n a fourth trimester, but children began to be born earlier, evolutionarily, to accommodate th e develo 6w59li pment of larger heads and brains and allow them to pass through the birth canal and th i leaves them with partially undeveloped digestive systems. Most childrene li will outgrow their reflux by their first birthday. However, a small osis requires both symptoms or complic 59li ations and reflux of stomach con Other investiga 59li tions may include esophagogastroduodenos 59li coBarium swallow X-rays should n ot be used for diagnosEsophageal manometry is not recommended for use in diagnosis being r ecommended only prior to surgembulatory esophageal pH monitoring may be usefu Investigations for H. pylori is not usually needed. The current gold standard for diagnosis of is esophageal pH monitoring. It is the most objecti ve test to diagnose t 59li he reflux disease and allows monitoring GERD patients in their response to me dical or surgical treatment. One practice li for diagnosis of GERD is a short-term treatment with prot on-pump inhibitors, we liith improvement in symptoms suggesting a positi 6w59li ve diagnosis. Short-term tre atment with proton-pump inhibitors may help predict abnormal 24-hr pH monitoring resul mber of endoscopic devices have been tested to treat chronic 59li heartburn. One system, Endocinch, puts stitches in the 59li lower esophogeal sphi 59li ncter (LES) to create small pleats to help strengthen the muscl e. However, long-term results weree li disappointing, and the device is no longer sold by Bard Anot her, the Stretta procedure, uses electrodes to apply radio-frequency energy to the e liLES. The long-term ou tcomes of both procedures compared to a Nissen fundoplication are still being determined. The NDO Surgical Plicator creates a plication, or fold, of tissue near the g
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