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Physiology of gastroesophageal reflux in the neonate

Alexandra Pottorff1, Eric B Ortigoza2, Rinarani Sanghavi1

  • 1Division of Pediatric Gastroenterology, Department of Pediatrics, UT Southwestern Medical Center, USA.

Seminars in Perinatology
|September 5, 2025
PubMed

Insights

Gastroesophageal reflux disease (GERD) is common in infants, especially those born preterm or in the NICU. Understanding infant GERD physiology is key to effective management.

Area of Science:

  • Pediatric Gastroenterology
  • Neonatology
  • Infant Physiology

Background:

  • Gastroesophageal reflux (GER) is normal in infants, but gastroesophageal reflux disease (GERD) causes significant symptoms like vomiting and weight loss.
  • GERD is prevalent in infants, leading to increased healthcare use.
  • Preterm infants and those in the NICU represent a special population with unique GERD risk factors.

Purpose of the Study:

  • To review the physiology of infant swallowing and upper gastrointestinal motility.
  • To examine the pathophysiology of infant GERD.
  • To discuss physiological differences in preterm infants relevant to GERD management.

Main Methods:

  • Literature review of infant gastrointestinal physiology.
  • Analysis of pathophysiology contributing to GERD in infants.
  • Focus on specific preterm infant physiological factors.

Main Results:

  • Normal infant swallowing and motility are detailed.
  • Pathophysiological mechanisms of infant GERD are explained.
  • Key physiological differences in preterm infants are highlighted.

Conclusions:

  • Understanding normal and abnormal infant upper GI function is crucial for GERD diagnosis.
  • Specific considerations for preterm infants are essential for optimal GERD management.
  • This review provides a foundation for managing GERD in medically complex infants.

Keywords:
Gastroesophageal reflux diseaseInfantsMotilityPhysiologyPreterm

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