Introduction Gastro esophageal reflux in neonates and infants is a well known clinical problem in both term and pre term infants, 1 especially for the first 3 months of life and usually resolves by 6-12 months of age. Although virtually all infants have some degree of GER, the severity of symptoms ranges widely from an occasional burp to persistent emesis. The symptoms resulting from GER disease in neonates are not very clear with regards to cause and association. 2 Most cases resolve spontaneously or with simple medical measures. 1 Serious complications such as esophagitis, stricture, and aspiration do occur but are uncommon under one year of age. Initial imaging often is directed towards the demonstration of reflux and its complications subjecting these infants to excessive and sometimes unnecessary radiation. Hence, we conducted this retrospective descriptive case study to determine the outcome in terms of resolution of the symptoms in these patients and tried to establish an institutional protocol for the investigation of these patients which might help others in this regard. Its emphasis is on proper patient selection and clinical history. Patients and Methods Between October, 2006 to September, 2007 a total of 53 neonates and infants with clinical suspicion of GER were referred to our Medical Imaging department for upper gastrointestinal contrast studies. There were 27 preterm and 26 full term babies. These patients included OPD referrals as well as inpatients from NICU and paediatric ward. Approval from ethical committee was not required because the study was an audit of an established and accepted study. The inclusion criteria were neonates and infants up to 1 year of age born to mothers who had no complication of pregnancy such as diabetes, hypertensive disease of pregnancy or IUGR, at a gestational age of 28-42 weeks, and not asphyxiated at birth. The exclusion criteria were incomplete follow up, presence of other co-morbids like necrotizing enterocolitis, congenital heart disease or meconium aspiration syndrome. Out of 53 patients, 32 were males and 21 were females. Twenty seven patients were preterm. Forty four patients had mild to moderate symptoms including spitting up, vomiting, coughing, irritability and poor feeding. Nine patients had severe symptoms like persistent and frequent vomiting, increasing tracheal secretions, recurrent episodes of pneumonia, stridor and poor weight gain. All infants with severe symptoms were preterm. Upper GI contrast studies were carried out in all 53 984 J Pak Med Assoc Original Article Gastro esophageal reflux: An over investigated entity in neonates and infants Zahid Anwar Khan, Sarfraz Ahmad, Muhammad Younus Sheikh Medical Imaging Department, King Abdul Aziz Hospital, National Guard Health Affairs, Saudi Arabia. Abstract Objectives: To determine the outcome of clinically suspected gastro esophageal reflux in neonates and infants. To find a protocol for evaluation of these patients in order to reduce unnecessary radiation to neonates and infants. Methods: Fifty three neonates and infants of up to 1 year of age with clinical suspicion of gastro esophageal reflux (GER) were referred for Upper gastro intestinal barium studies. This retrospective descriptive case study was carried out over a period of one year starting from October, 2006 to September, 2007. Positive cases were followed for another one year to see the final outcome. The neonate and infants of upto one year of age, referred from Neonatal intensive care unit (NICU), Paediatric ward and Out Patient Department (OPD) were included in this study. Results: Out of 53 cases 32 were positive for G.E.R and no reflux could be identified in rest of the patients. Out of these positive cases only 4 had massive or severe G.E.R. These patients were prescribed conservative and medical treatment and were advised to follow up in the O.P.D where on subsequent follow ups the medical treatment was stopped as there were no further complaints .These patients showed normal weight gain on subsequent O.P.D visits. Other positive cases only had mild to moderate G.E.R and they were managed conservatively. These patients showed normal weight gain on subsequent O.P.D visits with complete resolution of symptoms. Conclusion: Regurgitation or gastro esophageal reflux is a common finding in the first 3 months of life (especially in preterm infants) and usually resolves by 6-12 months of age and should not be over investigated (JPMA 60:984; 2010).