Regurgitation/vomiting (R/V) in infants often represents physiologic gastroesophageal reflux. When R/V is associated with other symptoms such as irritability, hematemesis or failure to thrive, esophagitis is often considered and upper endoscopy performed. However, R/V with associated symptoms may be caused by gastritis or duodenitis as well as esophagitis, and endoscopic biopsies limited to the esophagus may underestimate the frequency of peptic disease. We reviewed the pathologic findings of infants (<12 months old) to determine 1.) Whether gastritis and/or duodenitis were frequently seen with R/V and associated symptoms, and 2.) If these presenting symptoms could predict peptic disease. Eighty infants who underwent esophagogastroduodenoscopy (EGD) between 1990-95 for R/V with irritability (25 pts.), failure-to-thrive (37 pts.), hematemesis (12 pts.), or reactive airway disease (6 pts.) had biopsies of the stomach and/or duodenum which were reviewed. Gastritis and/or duodenitis were defined as acute or chronic inflammatory-cell infiltration with or without mucosal breach. 40 of 80 patients, (50%) had lower peptic disease (gastritis and/or duodenitis). Peptic disease was seen in 52% (13/25) of those with R/V ± irritability, 57%(21/37) of those with R/V and failure-to-thrive, 50% (6/12) of those with R/V and hematemesis, and 0% (0/6) of those with R/V and reactive airway disease.

Conclusion: Gastritis and/or duodenitis were seen frequently(50%) in infants with R/V and associated symptoms. By limiting endoscopic biopsies to the esophagus, a substantial percentage of patients with gastritis and/or duodenitis may be overlooked. Reactive airway disease was not associated with gastritis and/or duodenitis; otherwise R/V with or without irritability, failure to thrive or hematemesis was.