• gastro-oesophageal reflux disease
• cisapride

The coincidental appearance of the Cochrane Review Group's systematic appraisal of the utility of cisapride for gastro-oesophageal reflux (GOR) in children,¹ and the withdrawal of this drug in many countries² could not have been more appropriate. However, there exists a possibility that this serendipitous occurrence will undermine the impact of the Cochrane Review findings. Essentially, the outcome of the study was negative, with no benefits being shown for cisapride in improving the symptoms of GOR in children. In addition, the authors of the report were critical of the quality of data available, noting in particular evidence for substantial publication bias in favour of studies with a positive outcome. Both the immediate and wider implications of the findings of Augood and colleagues¹ are deserving of comment.

GOR in young children is a common occurrence. In the vast majority of children reflux is harmless, self limiting, and can be viewed as a physiological variant rather than a disease. This form of GOR is best managed with reassurance and ongoing clinical monitoring. In a minority of cases GOR is complicated by oesophagitis, respiratory symptoms, Sandifer syndrome or failure to thrive, and it is then referred to as GOR disease (GORD). Under such circumstances, medical and/or surgical intervention is usually necessary. The pathophysiology of GOR in children is still poorly understood. In particular the relation between GOR and GORD is far from clear.

The prokinetic agent cisapride induces …