Pediatric GERD

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Question 7: What is the prognosis of GERD in infants and children and what are prognostic factors?

Further investigations are needed in order to elucidate these hypotheses.

GERD symptoms may occur as a complication associated with GER, and it is important for clinicians to accurately diagnose and assess how best to manage the patient to improve symptoms and facilitate healing of the esophagus. Pediatric patients with GER who experience uncomplicated recurrent regurgitation should be managed conservatively with minimal testing and lifestyle modifications.

Thanks to pH-impedance studies, several authors have recently highlighted the role of weakly acid and non-acid reflux [28, 29, 30, 31, 32, 33, 34, 35]. Furthermore, a recent review reported that a significant percentage of patients with GERD-related respiratory symptoms do not improve despite an aggressive acid-suppressive therapy [36], thus supporting the hypothesis that respiratory symptoms are less related to acidity than GI symptoms. AXID(R) Oral Solution is a treatment for endoscopically diagnosed esophagitis, including erosive and ulcerative esophagitis, and associated heartburn due to gastroesophageal reflux disease (GERD) for up to 8 weeks. It is an alcohol-free, bubblegum-flavored, formulation of nizatidine approved by the United States Food and Drug Administration for use in pediatric patients aged 12 years and up in May 2004. IPEG guidelines for the surgical treatment of pediatric gastroesophageal reflux disease (GERD).

However, information is lacking on these trends and often does not control for other comorbidities that can serve as indicators for anti-reflux procedures. In JAMA Surgery, Dr. LaRiviere and colleagues published work that examined infants and children with GERD who required inpatient hospitalization and a subpopulation that progressed to anti-reflux procedures. The analysis included 141,190 children with GERD, 8.2% of whom underwent anti-reflux procedures during the 9-year study period. More than half of patients undergoing these procedures were 6 months of age or younger. Although about two-thirds of children receiving anti-reflux procedures had preoperative upper gastrointestinal tract fluoroscopy, the study found that these patients did not undergo a uniform workup.

However, it is important to mention that reporting of symptoms is unreliable in children under the age of approximately 8 years [1]. The reliability is even lower in infants and neurologically impaired children who are unable to report “troublesome” symptoms and in whom symptoms (or signs) reporting depends on their parents/caregivers. Of 374 infants, 161 were included, 64% aged 1-3 months (graph-1).

  • The most well-known prokinetic drug is cisapride, widely prescribed until 2000, when it was withdrawn due to cardiac toxicity which increased the risk of sudden death [97].
  • to provide guidance for primary care physicians, dietitians, and pediatric gastroenterologists.
  • Adult studies have since shown similar results.(113, 114) Therefore, because of this inadequate sensitivity, oropharyngeal monitoring is not recommended.
  • Our results suggest that dilation of intercellular space may be a potential histologic diagnostic criterion for EE [6 ].
  • The findings of this study showed that an 8-week course of esomeprazole treatment (0.2-1.0 mg/kg) healed esophageal erosions in 89% of children aged 1-11 years who had EE.
  • In a single pediatric study by Chiou et al, 15 patients underwent simultaneous oropharyngeal pH monitoring and pH-MII testing.(97) The authors failed to show any relationship between changes in the oropharyngeal pH and esophageal reflux events detected by pH-MII suggesting that oropharyngeal monitoring does not represent GER events.

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Several studies investigated possible correlation between endoscopic findings and clinical symptoms in this vulnerable cohort of children and failed to demonstrate any association [12,28,29]. Most of them failed to confirm correlation between reflux episodes detected by MII monitoring and endoscopy findings [12,29]. Study by Hojsak et al. showed that children with GI symptoms and endoscopically proven esophagitis had a higher number of all reflux episodes detected by pH-MII, but not by pH-metry alone [8]. The other survey established the relationship between the parameters of pH-MII and the presence of endoscopic reflux esophagitis in children [11].

Besides regurgitation and vomiting, GERD may present in children with many other signs or symptoms, the most frequent of which are heartburn, food refusal, dysphagia, feeding or sleeping disturbances, failure to thrive, persisting hiccups, impaired quality of life, and dental erosions. Respiratory symptoms, such as chronic cough, wheezing, hoarseness, laryngitis, chronic asthma, aspiration pneumonia, ear problems, and sinusitis, are atypical symptoms possibly associated with GERD. Nevertheless, the paucity of clinical studies, varying disease definitions, and small sample sizes do not allow to draw firm conclusions about their association with reflux [8].

5.3 Based on expert opinion, the working group suggests to use H2RAs in the treatment of reflux related erosive esophagitis in infants and children if PPIs are not available or contra-indicated (Algorithm 2). While increased risk of fractures, dementia, myocardial infarction, and renal disease have been reported in PPI users, no pediatric evidence convincingly documents these risks, and these studies are often confounded by comorbidities found in patients taking PPIs.

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