Gastroesophageal reflux disease (pediatrics) Quiz: Ace Your Exams

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A 12-year-old girl presents to clinic with her parents for follow-up of a four-month history of burning chest pain and sour-tasting regurgitation. Symptoms begin mostly after meals and worsen when lying down or at night. The patient reports nausea but has not had vomiting, dysphagia, weight loss, or hematemesis. There is no history of chronic medical conditions. Over-the-counter antacids have provided temporary relief. After a prior visit, the patient began avoiding acidic foods and caffeine and now sleeps in the left lateral decubitus position with pillows elevating the head. These changes have not alleviated the symptoms. Growth parameters are at the 50th percentile, and BMI is 22 kg/m² (85th percentile). Vital signs are normal. Physical examination is unremarkable, with no abdominal tenderness, organomegaly, or lymphadenopathy. Which of the following is the most appropriate next step in diagnosing this patient?

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