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Copyright ©The Author(s) 2020.
World J Gastroenterol. Nov 7, 2020; 26(41): 6322-6334
Published online Nov 7, 2020. doi: 10.3748/wjg.v26.i41.6322
Table 3 Diagnostic and therapeutic management of gastroesophageal reflux disease in pediatric patients with cystic fibrosis
InfantsChildren
Typical symptomsExcessive crying, back arching, regurgitation, irritabilityHeartburn, regurgitation
Diagnostic test
Indication
PPIs trialNot indicated; Exclude anatomically abnormalities12 year-old children with typical symptoms. Not use a trial of PPIs as a diagnostic test for GERD in patients presenting with extraesophageal symptoms
Barium swallowNot indicated, useful to exclude anatomical abnormalitiesNot indicated, useful to exclude anatomical abnormalities
EndoscopyIndicated in the presence of the alarm symptoms or to detect complications of GERD; to diagnose conditions that predispose or mimic GERDIndicated in the presence of alarm symptoms or to detect complications of GERD, to diagnose conditions that predispose to GERD (such as hiatal hernia) or to diagnose conditions that might mimic GERD (such as eosinophilic esophagitis, infectious esophagitis)
Esophageal manometryNot indicated
Not indicated
Not indicated
ScintigraphyNot indicated
Correlate persistent
Ph-MIIExtraesophageal symptoms with acid and non-acid GER events; Determine the efficacy of acid suppression therapy. Differentiate NERD, hypersensitive oesophagus and functional heartburn in patients with normal endoscopyCorrelate persistent extraesophageal symptoms with acid and non-acid GER events. Determine the efficacy of acid suppression therapy. Differentiate NERD, hypersensitive oesophagus and functional heartburn in patients with normal endoscopy
Therapy
AlginateAbsence of evidenceAbsence of evidence
PPIsFirst-line treatment of reflux-related erosive esophagitis with GERDFirst line of treatment in children with typical symptoms of GERD, and erosive esophagitis with GERD
ProkineticsNot indicatedNot indicated
FundoplicationLife-threatening complications of GERD after failure of optimal medical treatment; chronic conditions (i.e. neurologically impaired, cystic fibrosis) with a significant risk of GERD-related complicationsLife-threatening complications of GERD after failure of optimal medical treatment; Chronic conditions (i.e. neurologically impaired, cystic fibrosis) with a significant risk of GERD-related complications
GERD-related complicationsBarrett’s esophagusBarrett’s esophagus