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 k79j hen pulling off te 9jhe bottle or breast only to cry for it again, failure to gain ade quate weight, bad breath, and belching or burping are al k79j so common. Children may have one sympt om or many; no single symptom is universal in al k79j l children with GERD. Of the estimated 4 million babies born in the US each e8k79j year, up f them may have diffic ulties e e8k79j with reflux in the fi k79j rst few months of their lives, known as 'spitting theo ry for this is thee 9j "fourth trimester theory" which notes most animals are born with significan t mobility, but humans are rel k79j atively helple 9jess at bir k79j th,e 9j and suggests there may have once bee n a fourth trimester, but children began to be born earlier, evolutionarily, to accommodate th e develo e8k79j 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 9j will outgrow their reflux by their first birthday. However, a small osis requires both symptoms or complic k79j ations and reflux of stomach con Other investiga k79j tions may include esophagogastroduodenos k79j 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 k79j he reflux disease and allows monitoring GERD patients in their response to me dical or surgical treatment. One practice 9j for diagnosis of GERD is a short-term treatment with prot on-pump inhibitors, we 9jith improvement in symptoms suggesting a positi e8k79j 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 k79j heartburn. One system, Endocinch, puts stitches in the k79j lower esophogeal sphi k79j ncter (LES) to create small pleats to help strengthen the muscl e. However, long-term results weree 9j 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 9jLES. 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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