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1
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van Lennep M, Lansink F, Benninga MA, van Wijk MP. Age-dependent normal values for the 'Infant Gastroesophageal Reflux Questionnaire Revised'. Eur J Pediatr 2024; 183:445-452. [PMID: 37926716 PMCID: PMC10858078 DOI: 10.1007/s00431-023-05281-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
The Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) is used to score and evaluate gastroesophageal reflux (GER) related symptoms such as regurgitation, irritability and crying. A cut-off of ≥ 16 has been suggested to discriminate between GER and GER-disease. However, age-specific normal values were not assessed. Aim of this study was to determine age-specific normal values in healthy infants. Cross-sectional survey in healthy infants aged 0-24 months during their regular check-ups at well-baby clinics and through an online questionnaire using the I-GERQ-R. Infants with a history of (suspected) GER-disease were excluded. Spearman's correlation coefficient was calculated to explore age-related trends. A total of 979 healthy infants (47% male, median age 6 [0-24] months) were included. Median I-GERQ-R score, regardless of age, was 6 (range: 0-27). I-GERQ-R scores significantly decreased with age (rs = -0.569, p < 0.001). Of all infants, 49 (5%) had a score of ≥ 16 which previously has been considered 'suggestive of GER-disease'. Scores of ≥ 16 were most frequently seen in newborns aged 0-4 months (16% in 0-1 months to 4% in 3-4 months) and disappeared after the age of 16 months. High scores in the first months of life were caused by a high prevalence of regurgitation, colic-associated symptoms and hiccup frequency. Conclusion: Age-dependent normal values for the I-GERQ-R show that reflux symptoms decrease in the first 24 months of life in healthy infants. Scores of ≥ 16 should not necessarily be considered abnormal in young infants. Validation as a diagnostic tool for GER-disease using age-appropriate normal values is needed. What is Known: • The Infant Gastro Esophageal Reflux Questionnaire Revised (I-GERQ-R) was developed to objectively score and evaluate GER-related symptoms in infants. • Previously a cut off of ≥ 16 has been suggested to differentiate between gastro esophageal reflux (GER) and GER-disease. What is New: • We present age-specific normal values of the I-GERQ-R in healthy infants. • I-GERQ-R scores clearly decrease with age and up to 16% of young healthy infants have a score that is above the previously suggested cut-off score of 16 for GER-disease.
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Affiliation(s)
- Marinde van Lennep
- Amsterdam UMC location University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Meibergdreef 9, H7-292, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Fréderique Lansink
- Department of General Internal Medicine, University Hospital Leuven, Leuven, Belgium
| | - Marc A Benninga
- Amsterdam UMC location University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Meibergdreef 9, H7-292, PO Box 22700, 1100 DD, Amsterdam, The Netherlands
| | - Michiel P van Wijk
- Amsterdam UMC location University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Meibergdreef 9, H7-292, PO Box 22700, 1100 DD, Amsterdam, The Netherlands.
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Pediatric Gastroenterology, Emma Children's Hospital, Boelelaan 1117, Amsterdam, The Netherlands.
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Salvatore S, Vandenplas Y. Epidemiology of GER. GASTROESOPHAGEAL REFLUX IN CHILDREN 2022:1-14. [DOI: 10.1007/978-3-030-99067-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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3
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Vandenplas Y, Kindt S. Gastroesophageal Reflux. TEXTBOOK OF PEDIATRIC GASTROENTEROLOGY, HEPATOLOGY AND NUTRITION 2022:125-155. [DOI: 10.1007/978-3-030-80068-0_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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4
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Pados BF, Repsha C, Hill RR. The Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers. Glob Pediatr Health 2021; 8:2333794X211033130. [PMID: 34350308 PMCID: PMC8287340 DOI: 10.1177/2333794x211033130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to describe the development of the Gastrointestinal
and Gastroesophageal Reflux (GIGER) Scale for Infants and Toddlers, and
determine its factor structure and psychometric properties. Items were developed
to comprehensively assess gastrointestinal (GI) and gastroesophageal reflux
(GER) symptoms observable by a parent. Exploratory factor analysis on 391
responses from parents of children under 2 years old resulted in a 36-item scale
with 3 subscales. Internal consistency reliability was acceptable (α = .78-.94).
The GIGER total score and all 3 subscales were correlated with the Infant
Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R)
(P < .05) and Infant Gastrointestinal Symptoms Questionnaire
(IGSQ) (P < .05). GIGER total score was higher in infants
with a diagnosis of GER (P < .05) or constipation
(P < .05) compared to those without. The GIGER is a
parent-report measure of GI and GER symptoms in children under 2 years old with
adequate psychometric properties.
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5
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Ibañez VF, Peterson KM, Crowley JG, Haney SD, Andersen AS, Piazza CC. Pediatric Prevention: Feeding Disorders. Pediatr Clin North Am 2020; 67:451-467. [PMID: 32443986 DOI: 10.1016/j.pcl.2020.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Applied behavior analysis has the most empirical support as intervention for pediatric feeding disorders, when a child does not eat or drink a sufficient quantity or variety of food to maintain proper nutrition. Interdisciplinary collaboration is crucial for diagnosis, referral, and management of pediatric feeding disorders because the etiology is complex and multifactorial. Thus, our aim is to provide information about how to recognize a feeding disorder, to delineate the environmental variables implicated in the etiology and maintenance of feeding disorders, and to provide recommendations for prevention and intervention for feeding disorders based on the applied-behavior analytic literature.
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Affiliation(s)
- Vivian F Ibañez
- Children's Specialized Hospital and Rutgers University, 200 Somerset St, New Brunswick, NJ 08901, USA.
| | - Kathryn M Peterson
- Children's Specialized Hospital and Rutgers University, 200 Somerset St, New Brunswick, NJ 08901, USA
| | | | - Sarah D Haney
- University of Nebraska Medical Center's Munroe-Meyer Institute, 42nd and Emile, Omaha, NE 68198, USA
| | - Ashley S Andersen
- University of Nebraska Medical Center's Munroe-Meyer Institute, 42nd and Emile, Omaha, NE 68198, USA
| | - Cathleen C Piazza
- Rutgers University Graduate School of Applied and Professional Psychology and Children's Specialized Hospital, 152 Frelinghuysen Road, Piscataway, NJ 08854, USA
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6
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Yu YR, Cunningham ME, DeMello AS, Chiou EH, Kougias P, Wesson DE, Brandt ML, Lopez ME. Cost-Effectiveness Analysis of the Surgical Management of Infants Less than One Year of Age with Feeding Difficulties. J Pediatr Surg 2020; 55:187-193. [PMID: 31759653 DOI: 10.1016/j.jpedsurg.2019.09.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 09/29/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND We compared the cost-effectiveness of the common surgical strategies for the management of infants with feeding difficulty. METHODS Infants with feeding difficulty undergoing gastrostomy alone (GT), GT and fundoplication, or gastrojejunostomy (GJ) tube were enrolled between 2/2017 and 2/2018. A validated GERD symptom severity questionnaire (GSQ) and visual analog scale (VAS) to assess quality of life (QOL) were administered at baseline, 1 month, and every 6 months. Data collected included demographics, resource utilization, diagnostic studies, and costs. VAS scores were converted to quality adjusted life months (QALMs), and costs per QALM were compared using a decision tree model. RESULTS Fifty patients initially had a GT alone (71% laparoscopically), and one had a primary GJ. Median age was 4 months (IQR 3-8 months). Median follow-up was 11 months (IQR 5-13 months). Forty-three did well with GT alone. Six (12%) required conversion from GT to GJ tube, and one required a fundoplication. Of those with GT alone, six (14%) improved significantly so that their GT was removed after a mean of 7 ± 3 months. Overall, the median GSQ score improved from 173 at baseline to 18 after 1 year (p < 0.001). VAS scores also improved from 70/100 at baseline to 85/100 at 1 year (p < 0.001). ED visits (59%), readmissions (47%), and clinic visits (88%) cost $58,091, $1,442,139, and $216,739, respectively. GJ tube had significantly higher costs for diagnostic testing compared to GT (median $8768 vs. $1007, p < 0.001). Conversion to GJ tube resulted in costs of $68,241 per QALM gained compared to GT only. CONCLUSIONS Most patients improved with GT alone without needing GJ tube or fundoplication. GT and GJ tube were associated with improvement in symptoms and QOL. GJ tube patients reported greater gains in QALMS but incurred higher costs. Further analysis of willingness to pay for each additional QALM will help determine the value of care. STUDY AND LEVEL OF EVIDENCE Cost-effectiveness study, Level II.
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Affiliation(s)
- Yangyang R Yu
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Megan E Cunningham
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Annalyn S DeMello
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Eric H Chiou
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Panagiotis Kougias
- Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX
| | - David E Wesson
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Mary L Brandt
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Monica E Lopez
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
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Drapkin Z, Franchek-Roa K, Srinivas GL, Buchi KF, Miescier MJ. Is my baby normal? A review of seemingly worrisome but normal newborn signs, symptoms and behaviors. Am J Emerg Med 2019; 37:1153-1159. [PMID: 30952605 DOI: 10.1016/j.ajem.2019.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 12/20/2022] Open
Abstract
Infant patients are a unique challenge to emergency department (ED) physicians as the spectrum of normal infant signs, symptoms and behaviors are often difficult to differentiate from abnormal and potentially life-threatening conditions. In this article, we address some common chief complaints of neonates and young infants presenting to the ED, and contrast reassuring neonatal and young infant signs and symptoms against those that need further workup and intervention.
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Affiliation(s)
- Zachary Drapkin
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT, USA; Department of Surgery, Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
| | | | - Ganga L Srinivas
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Karen F Buchi
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Michael J Miescier
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, UT, USA
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8
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Sdravou K, Emmanouilidou-Fotoulaki E, Mitakidou MR, Printza A, Evangeliou A, Fotoulaki M. Children with diseases of the upper gastrointestinal tract are more likely to develop feeding problems. Ann Gastroenterol 2019; 32:217-233. [PMID: 31040618 PMCID: PMC6479649 DOI: 10.20524/aog.2019.0348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 11/22/2018] [Indexed: 12/26/2022] Open
Abstract
Feeding problems may give rise to a number of adverse effects with organic, psychological, developmental and social impact. Specific medical conditions, especially diseases of the gastrointestinal system, are known to be associated with feeding problems. We searched databases, including MEDLINE and the Cochrane Library, for papers published in English from 1990 to March 2018. Keywords included "gastrointestinal diseases", "gastroesophageal reflux disease", "eosinophilic esophagitis", "food allergy", "children", "infants", and "feeding problems". We concluded that children with diseases of the upper gastrointestinal tract, especially those with gastroesophageal reflux disease and eosinophilic esophagitis, are more likely to develop feeding problems. However, further epidemiological studies are needed to determine the prevalence and the specific characteristics of feeding problems in children with certain upper gastrointestinal diseases, as well as the exact causal relationship between them.
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Affiliation(s)
- Katerina Sdravou
- 4 Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital "Papageorgiou" (Katerina Sdravou, Elpida Emmanouilidou-Fotoulaki, Maria-Rafaela Mitakidou, Athanasios Evangeliou, Maria Fotoulaki), Thessaloniki, Greece
| | - Elpida Emmanouilidou-Fotoulaki
- 4 Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital "Papageorgiou" (Katerina Sdravou, Elpida Emmanouilidou-Fotoulaki, Maria-Rafaela Mitakidou, Athanasios Evangeliou, Maria Fotoulaki), Thessaloniki, Greece
| | - Maria-Rafaela Mitakidou
- 4 Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital "Papageorgiou" (Katerina Sdravou, Elpida Emmanouilidou-Fotoulaki, Maria-Rafaela Mitakidou, Athanasios Evangeliou, Maria Fotoulaki), Thessaloniki, Greece
| | - Anastasia Printza
- 1 Otolaryngology Department, Medical Department, School of Health Sciences, Aristotle University of Thessaloniki (Anastasia Printza), Thessaloniki, Greece
| | - Athanasios Evangeliou
- 4 Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital "Papageorgiou" (Katerina Sdravou, Elpida Emmanouilidou-Fotoulaki, Maria-Rafaela Mitakidou, Athanasios Evangeliou, Maria Fotoulaki), Thessaloniki, Greece
| | - Maria Fotoulaki
- 4 Department of Pediatrics, School of Medicine, Aristotle University of Thessaloniki, General Hospital "Papageorgiou" (Katerina Sdravou, Elpida Emmanouilidou-Fotoulaki, Maria-Rafaela Mitakidou, Athanasios Evangeliou, Maria Fotoulaki), Thessaloniki, Greece
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9
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Abstract
OBJECTIVE The aim of this study was to determine whether technetium-99m (Tc) nanocolloid was a suitable alternative tracer for carrying out milk scan studies in pediatric patients. PARTICIPANTS AND METHODS Twenty-seven milk scans performed with Tc nanocolloid were retrospectively assessed for identification of significant esophageal hold-up, gastroesophageal reflux, pulmonary aspiration, and gastric emptying (GE). Scans were also assessed for liver, spleen, and bone marrow uptake. GE results were compared with those of 27 randomly selected normal GE studies carried out using Tc tin colloid. RESULTS None of the studies had liver, spleen, or bone marrow uptake, and all studies were interpretable. Significant esophageal hold-up and gastroesophageal reflux was observed in 11 and 48% of the patients, respectively. Only one patient had evidence of pulmonary aspiration, and all patients had normal GE at 2 h after radiolabeled milk ingestion. The average rate of GE at 2 h was faster in the Tc nanocolloid group compared with the Tc tin colloid group (8.85% retained±8.96% vs. 15.48% retained±10.52%, P=0.016). CONCLUSION Our findings show that Tc nanocolloid is technically a suitable alternative to Tc sulfur colloid for performing milk scans. However, we could not conclude with certainty on the comparison of the GE rates of Tc nanocolloid and Tc tin colloid. This was because of the variability in the two population groups as well as the fact that the milk that was used in each patient was individualized to the patient and was not standardized.
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Ciciora SL, Woodley FW. Optimizing the Use of Medications and Other Therapies in Infant Gastroesophageal Reflux. Paediatr Drugs 2018; 20:523-537. [PMID: 30198060 DOI: 10.1007/s40272-018-0311-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gastroesophageal reflux (GER) is the retrograde movement of gastric (and sometimes duodenal) contents into the esophagus. While the majority of GER is physiologic, for patients, it can be associated with symptoms. While some symptoms are merely bothersome (crying), others can be life threatening (cough, gagging, choking). The main driver of GER in infants is the frequent feedings that produce increased intra-abdominal pressure, which is known to trigger transient relaxations of the lower esophageal sphincter. The recent 2018 clinical practice guidelines reported by the North American and European Societies for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN/ESPGHAN) have recommended non-pharmacologic management initially with subsequent consideration of brief trials with acid suppressants. The main target for these acid suppressants is the gastric parietal cells. Our review of the literature has revealed a paucity of data regarding the use of histamine-2 receptor antagonists and proton pump inhibitors in infants. Despite the absence of well-controlled clinical studies, the prescription rate of these medications has increased internationally. Risks to patients of all ages have become increasingly recognized, with new associations being reported all too often. Here we report our review of all pharmacologic modalities as well as some non-surgical options.
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Affiliation(s)
- Steven L Ciciora
- Division of Gastroenterology, Hepatology and Nutrition, Center for Functional Motility Disorders, Nationwide Children's Hospital, Columbus, OH, 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Frederick W Woodley
- Division of Gastroenterology, Hepatology and Nutrition, Center for Functional Motility Disorders, Nationwide Children's Hospital, Columbus, OH, 43205, USA. .,Department of Pediatrics, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA.
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11
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Cystic Fibrosis and gastroesophageal reflux disease. J Cyst Fibros 2018; 16 Suppl 2:S2-S13. [PMID: 28986024 DOI: 10.1016/j.jcf.2017.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
Gastroesophageal reflux is common in children and adults with cystic fibrosis (CF). Pathological gastroesophageal reflux disease (GERD) is also frequent in patients of all ages with CF. This article reviews the pathophysiology, diagnostic work-up, management options, complications, and future directions in the evaluation and management of GERD - unique to and pertinent for - patients with CF in particular.
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12
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Salvatore S, Savino F, Singendonk M, Tabbers M, Benninga MA, Staiano A, Vandenplas Y. Thickened infant formula: What to know. Nutrition 2018; 49:51-56. [PMID: 29495000 DOI: 10.1016/j.nut.2017.10.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/21/2017] [Accepted: 10/05/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This study aimed to provide an overview of the characteristics of thickened formulas to aid health care providers manage infants with regurgitations. METHODS The indications, properties, and efficacy of different thickening agents and thickened formulas on regurgitation and gastroesophageal reflux in infants were reviewed. PubMed and the Cochrane database were searched up to December 2016. RESULTS Based on the literature review, thickened formulas reduce regurgitation, may improve reflux-associated symptoms, and increase weight gain. However, clinical efficacy is related to the characteristics of the formula and of the infant. Commercial thickened formulas are preferred over the supplementation of standard formulas with thickener because of the better viscosity, digestibility, and nutritional balance. Rice and corn starch, carob bean gum, and soy bean polysaccharides are available as thickening agents. Hydrolyzed formulas have recently shown promising additional benefit. CONCLUSIONS Thickened formulas reduce the frequency and severity of regurgitation and are indicated in formula-fed infants with persisting symptoms despite reassurance and appropriate feeding volume intake.
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Affiliation(s)
- Silvia Salvatore
- Clinical Pediatrica di Varese, Universita dell'Insubria, Varese, Italy
| | - Francesco Savino
- Ospedale Infantile Regina Margherita, Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maartje Singendonk
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands
| | - Merit Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands
| | - Annamaria Staiano
- Department of Translation Medical Science, Section of Pediatrics, University of Naples, Federico II, Italy
| | - Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
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13
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Abstract
This relationship between gastroesophageal reflux and airway disorders is complex, possibly bidirectional, and not clearly defined. The tools used to investigate gastroesophageal reflux are mostly informative about involvement of gastroesophageal reflux within the gastrointestinal tract, although they are often utilized to study the relationship between gastroesophageal reflux and airway issues with are suspected to occur in relation to reflux. These modalities often lack specificity for reflux-related airway disorders. Co-incidence of gastroesophageal reflux and airway disorders does not necessarily infer causality. While much of our focus has been on managing acidity, controlling refluxate is an area that has not been traditionally aggressively pursued. Our management approach is based on some of the evidence presented, but also often from a lack of adequate study to provide further guidance.
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Affiliation(s)
- Asim Maqbool
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA.
| | - Matthew J Ryan
- Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
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14
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Pediatric Gastroesophageal Reflux Disease: Systematic Review on Prognosis and Prognostic Factors. J Pediatr Gastroenterol Nutr 2018; 66:239-243. [PMID: 28753185 DOI: 10.1097/mpg.0000000000001697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In this systematic review, we summarize the evidence on prognosis and prognostic factors of pediatric gastroesophageal reflux disease (GERD). A structured search of Embase and MEDLINE/PubMed (inception to April 2016) yielded 5365 references; 4 publications met our inclusion criteria (risk of bias moderate-high). Definitions and outcome measures varied widely between studies. The percentage of children with a diagnosis of GERD with esophagitis that had persisting symptoms and/or were on antireflux medication at follow-up (12 months to >5 years) ranged from 23% (weekly symptoms) to 68% (antireflux medication), depending on definition used. In children with a diagnosis of GERD without esophagitis, 1.4% developed esophagitis at follow-up (>5 years); none developed Barrett esophagus. In conclusion, prognostic studies on pediatric GERD are of limited quality and show large methodological heterogeneity. Based on these studies, we are unable to identify those children at risk for unfavorable outcome with regards to GERD symptoms or endoscopic complications.
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15
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Abstract
Feeding problems in infants and young children are common. In healthy children who are developing and growing normally, feeding problems are usually not serious and can be managed conservatively by reassuring the family and providing them with anticipatory guidance and follow-up. A majority of serious childhood feeding problems occur in children who have other medical, developmental, or behavioral problems. These are best evaluated and treated by an interprofessional team who can identify and address issues in the medical and/or developmental history, problems with oral motor control and function, problems with swallowing, and behavioral and/or sensory issues that may interfere with normal feeding.
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Affiliation(s)
- Kathleen C Borowitz
- Department of Therapy Services, University of Virginia Health System, Box 386 HSC, Charlottesville, VA 22908, USA.
| | - Stephen M Borowitz
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Virginia, Box 386 HSC, Charlottesville, VA 22908, USA
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16
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Singendonk MMJ, Brink AJ, Steutel NF, van Etten-Jamaludin FS, van Wijk MP, Benninga MA, Tabbers MM. Variations in Definitions and Outcome Measures in Gastroesophageal Reflux Disease: A Systematic Review. Pediatrics 2017; 140:e20164166. [PMID: 28751614 DOI: 10.1542/peds.2016-4166] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2017] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Gastroesophageal reflux (GER) is defined as GER disease (GERD) when it leads to troublesome symptoms and/or complications. We hypothesized that definitions and outcome measures in randomized controlled trials (RCTs) on pediatric GERD would be heterogeneous. OBJECTIVES Systematically assess definitions and outcome measures in RCTs in this population. DATA SOURCES Data were obtained through Cochrane, Embase, Medline, and Pubmed databases. STUDY SELECTION We selected English-written therapeutic RCTs concerning GERD in children 0 to 18 years old. DATA EXTRACTION Data were tabulated and presented descriptively. Each individual parameter or set of parameters with unique criteria for interpretation was considered a single definition for GER(D). Quality was assessed by using the Delphi score. RESULTS A total of 2410 unique articles were found; 46 articles were included. Twenty-six (57%) studies defined GER by using 25 different definitions and investigated 25 different interventions. GERD was defined in 21 (46%) studies, all using a unique definition and investigating a total of 23 interventions. Respectively 87 and 61 different primary outcome measures were reported by the studies in GER and GERD. Eight (17%) studies did not report on side effects. Of the remaining 38 (83%) studies that did report on side effects, 18 (47%) included this as predefined outcome measure of which 4 (22%) as a primary outcome measure. Sixteen studies (35%) were of good methodological quality. LIMITATIONS Only English-written studies were included. CONCLUSIONS Inconsistency and heterogeneity exist in definitions and outcome measures used in RCTs on pediatric GER and GERD; therefore, we recommend the development of a core outcome set.
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Affiliation(s)
- Maartje M J Singendonk
- Department of Pediatric Gastro Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands;
| | - Anna J Brink
- Department of Pediatric Gastro Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Nina F Steutel
- Department of Pediatric Gastro Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, and
| | | | - Michiel P van Wijk
- Department of Pediatric Gastro Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
- Department of Pediatric Gastroenterology and Nutrition, VU Medical Center, Amsterdam, Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastro Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
| | - Merit M Tabbers
- Department of Pediatric Gastro Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, Netherlands
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17
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Bar-Sever Z. Scintigraphic Evaluation of Gastroesophageal Reflux and Pulmonary Aspiration in Children. Semin Nucl Med 2017; 47:275-285. [PMID: 28417856 DOI: 10.1053/j.semnuclmed.2016.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Gastroesophageal reflux (GER) and pulmonary aspiration are encountered in children of all ages. Signs, symptoms, and complications vary from mild and transient to severe life-threatening conditions. This review will present relevant clinical information on these conditions as well as common diagnostic procedures. The role of scintigraphic techniques used in the evaluation of these conditions will be discussed in detail including protocols and performance in comparison to other diagnostic methods.
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Affiliation(s)
- Zvi Bar-Sever
- Department of nuclear medicine, Schneider Children's Medical Center, Petah Tikva, Israel.
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18
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Singendonk MMJ, Benninga MA, van Wijk MP. Reflux monitoring in children. Neurogastroenterol Motil 2016; 28:1452-9. [PMID: 27682990 DOI: 10.1111/nmo.12922] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 12/23/2022]
Abstract
Recently, multichannel intraluminal impedance (MII) monitoring was added to the repertoire of tests to evaluate the (patho)physiology of gastroesophageal reflux (GER) in children. Its advantage above the sole monitoring of the esophageal pH lies in the ability of the detection of both acid and nonacid GER and to discern between liquid and gas GER. Currently, combined 24 h pH-MII monitoring is recommended for evaluation of gastro-esophageal reflux disease (GERD) and its relation to symptoms in infants and children, despite the lack of reference values in these age groups. There is new evidence in the current issue of this Journal supporting the role of pH-MII monitoring for the evaluation of children presenting with gastrointestinal symptoms suggestive of GERD and the prediction of the presence of reflux esophagitis. However, several issues should be taken into account when performing pH-MII clinically.
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Affiliation(s)
- M M J Singendonk
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
| | - M A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands
| | - M P van Wijk
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, The Netherlands.,Department of Pediatric Gastroenterology, VU University Medical Centre, Amsterdam, The Netherlands
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19
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Abstract
Comprehensive guidelines for the diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) were developed by the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition. GERD is reflux associated with troublesome symptoms or complications. The recognition of GER and GERD is relevant to implement best management practices. A conservative management is indicated in infants with uncomplicated physiologic reflux. Children with GERD may benefit from further evaluation and treatment. Since the publications of the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition guidelines in 2009, no important novelties in drug treatment have been reported. Innovations are mainly restricted to the management of regurgitation in infants. During the last 5 years, pros and cons of multichannel intraluminal impedance have been highlighted. However, overall 'not much has changed' in the diagnosis and management of GER and GERD in infants and children.
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Affiliation(s)
| | - Bruno Hauser
- a Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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20
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Nikaki K, Woodland P, Sifrim D. Adult and paediatric GERD: diagnosis, phenotypes and avoidance of excess treatments. Nat Rev Gastroenterol Hepatol 2016; 13:529-42. [PMID: 27485786 DOI: 10.1038/nrgastro.2016.109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Detailed investigations and objective measurements in patients with symptoms of gastro-oesophageal reflux should be performed with the intent of making the correct diagnosis, thus enabling choice of appropriate therapy. Establishing the most effective therapy is particularly important in adults who do not respond to standard treatment and in children. The use of PPIs for suspected GERD has increased substantially over the past decade, providing great relief in patients with acid-related symptoms, but also leading to adverse effects and a considerable economic burden. Adults with functional heartburn do not benefit from PPIs, while prolonged PPI use in patients with extraoesophageal symptoms remains a controversial area. Moreover, PPIs are not indicated in infants with GERD unless symptoms are proven to be acid-related. With regard to antireflux surgery, patients must be carefully selected to avoid the need for ongoing PPI treatment postoperatively. Correct diagnosis and phenotyping of patients with symptoms attributed to gastro-oesophageal reflux through detailed investigations is therefore imperative, leading to improved patient outcomes and rationalized use of available treatment options. In this Review, we outline currently available diagnostic tests and discuss approaches to limit any unnecessary medical or surgical interventions.
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Affiliation(s)
- Kornilia Nikaki
- Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 26 Ashfield Street, London E1 2AJ, UK
| | - Philip Woodland
- Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 26 Ashfield Street, London E1 2AJ, UK
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 26 Ashfield Street, London E1 2AJ, UK
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21
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Abstract
In the United States, the Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act continue to promote clinical trials in pediatric populations across all age ranges. In 2014 and 2015, over 70 changes were made to drug labels with updates on information regarding pediatric populations. Additionally, multiple new therapies have received first-approvals for the treatment of pediatric indications ranging form rare genetic metabolic diseases to oncology. In the European Union, there have been more than 30 new authorizations for medicines used in children and 130 approved pediatric investigation plans. Despite the progress that has been made over the last two years, much work remains to further the development of safe and effective therapies for pediatric patients.
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Affiliation(s)
- Laura A Wang
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt Street, Durham, NC 27705, USA; Department of Pediatrics, Children's Health Center, College of Medicine, Duke University, T901, Durham, NC 27705, USA.
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 301 Pharmacy Lane, CB #7569, Chapel Hill, NC 27599, USA
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22
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Neonatal Histamine-2 Receptor Antagonist and Proton Pump Inhibitor Treatment at United States Children's Hospitals. J Pediatr 2016; 174:63-70.e3. [PMID: 27131401 PMCID: PMC4925209 DOI: 10.1016/j.jpeds.2016.03.059] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/15/2016] [Accepted: 03/23/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine treatment frequency and duration of histamine-2 receptor antagonist (H2RA)/proton pump inhibitor (PPI) use among infants hospitalized within US children's hospital neonatal intensive care units and evaluate diagnoses/demographic factors associated with use. STUDY DESIGN We retrospectively analyzed a cohort of neonatal intensive care unit infants admitted to 43 US children's hospitals within the Pediatric Health Information System database between January 2006 and March 2013 to determine H2RA/PPI treatment frequency, timing/duration of treatment, factors associated with use, percent of infants remaining on treatment at discharge, and interhospital prescribing variation. We used a modified Poisson regression to calculate the adjusted probability of infants ever receiving H2RAs/PPIs in relation to diagnosis, gestation, and sex. RESULTS Of the 122 002 infants evaluated, 23.8% (n = 28 989) ever received an H2RA or PPI; 19.0% received H2RAs (n = 23 187), and 10.5% (n = 12 823) received PPIs. Extremely preterm infants and term infants were the most likely to receive H2RA and PPI treatment. Infants with gastroesophageal reflux disease (relative risk [RR] = 3.13) and congenital heart disease (RR = 2.41) had the highest H2RA/PPI treatment probabilities followed by those with an ear, nose, and throat diagnosis (RR = 2.34; P < .05). The majority of treated infants remained treated at discharge. CONCLUSIONS Despite limited evidence and increasing safety concerns, H2RAs/PPIs are frequently prescribed to extremely preterm neonates and those with congenital anomalies and continued through discharge. Our findings support the need for innovative studies to examine the comparative effectiveness and safety of H2RA/PPIs vs no treatment in these high-risk neonatal populations.
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23
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Parker MG, Rybin D, Heeren TC, Thoyre S, Corwin MJ. Postdischarge Feeding Interactions and Neurodevelopmental Outcome at 1-Year Corrected Gestational Age. J Pediatr 2016; 174:104-10. [PMID: 27178622 PMCID: PMC8690973 DOI: 10.1016/j.jpeds.2016.03.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 03/10/2016] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the extent to which postdischarge feeding behaviors and interactions among caregiver-preterm infant dyads are associated with infant neurodevelopment at 1-year corrected gestational age (CGA). STUDY DESIGN We studied 119 preterm infants born <34 weeks gestation and <1750 g at birth, and their caregivers, enrolled in the Collaborative Home Infant Monitoring Evaluation with in-person feeding assessments according to the Nursing Child Assessment Feeding Scale (NCAFS) at 39-59 weeks postmenstrual age that completed Bayley Scales of Infant Development, Second Edition testing at 1 year CGA. RESULTS Mean ± SD gestational age was 29.6 ± 2.4 weeks, and birth weight was 1260 ± 320 g. After adjustment for maternal and infant demographics, gestational age at birth, discharge and birth weight, mode of infant feeding, and caregiver type during the postdischarge NCAFS assessment, overall NCAFS scores were positively associated with higher 1-year CGA Bayley mental developmental index (MDI) scores (for each 1 SD increase in overall NCAFS score, MDI increased by 2.8 [95% CI 0.7, 4.9] points). Among individual NCAFS domains, strongest effects were seen for caregiver responsiveness to infant distress, such that, compared with dyads having domain scores of 11 (highest possible score), the adjusted mean difference in MDI was 8.3 points (95% CI -15.2, -1.4) lower among dyads with scores <9. CONCLUSIONS Caregiver-preterm infant feeding interaction and caregiver responsiveness to preterm infant feeding distress were associated with preterm infant Bayley MDI at 1-year CGA. Caregiver-infant feeding interaction may represent a modifiable factor to improve the neurodevelopment of at-risk preterm infants.
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Affiliation(s)
| | - Denis Rybin
- Department of Biostatistics, Boston University School of Public Health
| | - Timothy C. Heeren
- Department of Biostatistics, Boston University School of Public Health
| | - Suzanne Thoyre
- School of Nursing, University of North Carolina, Chapel Hill
| | - Michael J. Corwin
- Department of Pediatrics, Boston University School of Medicine,Slone Epidemiology Center at Boston University
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24
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Lieu JEC, Muthappan PG, Uppaluri R. Association of Reflux With Otitis Media in Children. Otolaryngol Head Neck Surg 2016; 133:357-61. [PMID: 16143181 DOI: 10.1016/j.otohns.2005.05.654] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: To confirm the finding of pepsin/pepsinogen in middle ear fluid of children with chronic or recurrent otitis media (OME or ROM), and to ask parents about symptoms associated with gastroesophageal reflux (GER).METHODS: Middle ear fluid was collected from children undergoing tympanostomy tube placement. We tested this fluid for pepsin/pepsinogen using a proteolytic enzyme assay and an ELISA. Parents completed questionnaires about symptoms of GER in their children.RESULTS: We collected 36 samples from 22 children; 16 of 22 children (73%) were positive with the proteolytic assay; 17 (77%) were positive with ELISA. Questionnaires did not show increased GER symptoms.CONCLUSIONS: We replicated the finding of pepsin/pepsinogen in middle ear fluid of children with OME or ROM, but did not find any increase in GER symptoms. Further research is needed to establish a causative link between GER and OM.
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Affiliation(s)
- Judith E C Lieu
- Department of Otolaryngology--Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
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25
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Papachrisanthou MM, Davis RL. Clinical Practice Guidelines for the Management of Gastroesophageal Reflux and Gastroesophageal Reflux Disease: Birth to 1 Year of Age. J Pediatr Health Care 2015; 29:558-64. [PMID: 26318381 DOI: 10.1016/j.pedhc.2015.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/17/2022]
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26
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Abstract
Recent guidelines focus on a non-interventionist approach to management of gastro-oesophageal reflux in infancy and emphasise the importance of explanation, reassurance and simple measures such as attention to feeding. Relying on clinical history alone leads to over diagnosis of disease, and widely used medications are often ineffective for symptom relief and carry significant risk of harm. The association between vomiting in infancy and other problems such as crying and poor feeding should not be interpreted as implying causality. When there are strong pointers to underlying gastro-oesophageal reflux disease, invasive investigations are required in order to formulate appropriate intervention.
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27
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Sanchez K, Spittle AJ, Allinson L, Morgan A. Parent questionnaires measuring feeding disorders in preschool children: a systematic review. Dev Med Child Neurol 2015; 57:798-807. [PMID: 25809003 DOI: 10.1111/dmcn.12748] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2015] [Indexed: 01/25/2023]
Abstract
AIM Preschool feeding disorders are common and debilitating and are associated with a range of developmental and medical issues. Parent report allows assessment of feeding in a naturalistic environment over time, with advantages over time-limited, clinic-based observations. However, little is understood about the limitations and advantages of current parent-report measures. We aimed to systematically review the psychometrics and clinometrics of parent-administered feeding questionnaires. METHOD Five search engines were used to identify questionnaires that met inclusion criteria, i.e. being norm-or criterion-referenced, child focused, appropriate for preschool children, and measured two or more feeding domains (e.g. dysphagia/oral motor delay, food refusal). RESULTS In total 3535 abstracts were identified and 215 full-text articles were evaluated. Five questionnaires met the criteria. The Behavioral Pediatrics Feeding Assessment Scale (BPFAS) was the most reliable questionnaire identified, with good test-retest reliability and internal consistency. More predictive and concurrent validity data was available for the BPFAS, the Mealtime Behavior Questionnaire, and the Montreal Children's Hospital Feeding Scale than for other measures. INTERPRETATION Further research is needed on the psychometric properties of feeding questionnaires used in research and clinical practice. To date, the BPFAS has the most comprehensive reliability and validity data of any parent-administered feeding questionnaire for preschool children.
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Affiliation(s)
- Katherine Sanchez
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,The Royal Women's Hospital, Parkville, Vic., Australia
| | - Leesa Allinson
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia.,The Royal Women's Hospital, Parkville, Vic., Australia
| | - Angela Morgan
- Murdoch Children's Research Institute, Parkville, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
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28
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Freitas DA, Dias FAL, Chaves GSS, Ferreira GMH, Ribeiro CTD, Guerra RO, Mendonça KMPP. Standard (head-down tilt) versus modified (without head-down tilt) postural drainage in infants and young children with cystic fibrosis. Cochrane Database Syst Rev 2015; 2015:CD010297. [PMID: 25756796 PMCID: PMC6481451 DOI: 10.1002/14651858.cd010297.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postural drainage is used primarily in infants with cystic fibrosis from diagnosis up to the moment when they are mature enough to actively participate in self-administered treatments. However, there is a risk of gastroesophageal reflux associated with this technique. OBJECTIVES To compare the effects of standard postural drainage (greater (30° to 45° head-down tilt) and lesser (15° to 20° head-down tilt)) with modified postural drainage (greater (30º head-up tilt) or lesser (15º to 20º head-up tilt)) with regard to gastroesophageal reflux in infants and young children up to six years old with cystic fibrosis in terms of safety and efficacy. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register. We also searched the reference lists of relevant articles and reviews. Additional searches were conducted on ClinicalTrials.gov and on the WHO International Clinical Trials Registry Platform for any planned, ongoing and unpublished studies.The date of the most recent literature searches: 20 January 2015. SELECTION CRITERIA We included randomised controlled studies that compared two postural drainage regimens (standard and modified postural drainage) with regard to gastroesophageal reflux in infants and young children (up to and including six years old) with cystic fibrosis. DATA COLLECTION AND ANALYSIS Two review authors independently selected the studies to be included in the review, assessed their risk of bias and extracted data. MAIN RESULTS Two studies, including 40 participants, were eligible for inclusion in the review. The studies were different in terms of the age of participants, the angle of tilt, the reported outcomes, the number of sessions and the study duration. The following outcomes were measured: appearance or exacerbation of gastroesophageal reflux episodes; percentage of peripheral oxygen saturation; number of exacerbations of upper respiratory tract symptoms; number of days on antibiotics for acute exacerbations; chest X-ray scores; and pulmonary function tests. One study reported that postural drainage with a 20° head-down position did not appear to exacerbate gastroesophageal reflux. However, the majority of the reflux episodes reached the upper oesophagus. The second included study reported that modified postural drainage (30º head-up tilt) was associated with fewer number of gastroesophageal reflux episodes and fewer respiratory complications than standard postural drainage (30º head-down tilt). The included studies had an overall low risk of bias. Data were not able to be pooled by meta-analysis due to differences in the statistical presentation of the data. AUTHORS' CONCLUSIONS The available evidence regarding the comparison between the two regimens of postural drainage is still weak due to the small number of included studies, the small number of participants assessed, the inability to perform any meta-analyses and some methodological issues with the studies. However, it may be inferred that the use of a postural regimen with a 30° head-up tilt is associated with a lower number of gastroesophageal reflux episodes and fewer respiratory complications in the long term. The 20º head-down postural drainage position was not found to be significantly different from the 20º head-up tilt modified position. Nevertheless, the fact that the majority of reflux episodes reached the upper oesophagus should make physiotherapists carefully consider their treatment strategy.
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Affiliation(s)
- Diana A Freitas
- Federal University of Rio Grande do NorteDepartment of Physical TherapyAvenida Senador Salgado Filho3000, Bairro Lagoa NovaNatalBrazil59078‐970
| | - Fernando AL Dias
- Federal University of ParanáDepartment of PhysiologyCentro Politécnico, Jardim das AméricasCaixa Postal 19031CuritibaBrazil81531‐980
| | - Gabriela SS Chaves
- Federal University of Minas GeraisRehabilitation Science ProgramBelo HorizonteBrazil
| | - Gardenia MH Ferreira
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaNatalBrazil59072‐970
| | - Cibele TD Ribeiro
- Federal University of ParanáDepartment of PhysiologyCentro Politécnico, Jardim das AméricasCaixa Postal 19031CuritibaBrazil81531‐980
| | - Ricardo O Guerra
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaNatalBrazil59072‐970
| | - Karla MPP Mendonça
- Federal University of Rio Grande do NortePhD Program in Physical TherapyAvenida Senador Salgado Filho 3000, Lagoa NovaNatalBrazil59072‐970
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29
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Quitadamo P, Di Nardo G, Miele E, Campione S, Mancusi V, Oliva S, Rossi P, Tiberti A, Staiano A, D'Armiento M. Gastroesophageal reflux in young children and adolescents: Is there a relation between symptom severity and esophageal histological grade? J Pediatr Gastroenterol Nutr 2015; 60:318-321. [PMID: 25373865 DOI: 10.1097/mpg.0000000000000614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND The pediatric literature about the correlation between symptoms and histological lesions in patients investigated for gastroesophageal reflux disease is scarce and inconclusive. The primary aim of the present study was to assess the relation between the complained symptom severity and the esophageal histological grade, through the use of validated and reliable scores. METHODS All children ages between 2 and 17 years referred to perform upper gastrointestinal endoscopy because of gastroesophageal reflux disease symptoms were asked to complete the Pediatric Gastroesophageal Symptom and Quality of Life validated questionnaire, investigating the main symptoms complained and their impact on daily life and school activities. Esophageal mucosal samples taken during the procedure were analyzed and scored according to the Yerian-Fiocca classification. RESULTS A total of 164 children were included in the study. No significant association was found between symptomatic score and histological score (r(s): 0.05, P: 0.49). Even when focusing only on adolescents with heartburn or chest pain, no correlation between symptom severity and esophageal lesions was found (r(s): -0.18, P: 0.264). Intercellular space diameter values did not mirror symptom severity. CONCLUSIONS The main finding of this study on children with reflux symptoms is the lack of correlation between symptom severity and esophageal histological grade. The magnitude of intercellular spaces was found not to be related with the clinical score as well.
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Affiliation(s)
- Paolo Quitadamo
- *Department of Translational Medical Science, Section of Pediatrics, University of Naples "Federico II", Naples †Department of Pediatrics, "La Sapienza" University, Rome ‡Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples, Naples §Department of Radiological Sciences, Oncology, and Anatomical Pathology, "La Sapienza" University, Rome, Italy
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30
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Abstract
OBJECTIVES It is unclear how diagnostic tests for gastroesophageal reflux disease (GERD) in children relate to the course of symptoms during follow-up. METHODS During 1 year, all children (ages 0-18 years), who underwent pH-metry and/or pH multichannel intraluminal impedance (MII), were included after written informed consent was obtained. pH-metry and pH-MII test characteristics, such as reflux index (RI, % time that esophageal pH < 4), were obtained from the measurements. A questionnaire containing subcategories (medical history, gastrointestinal [GI] symptoms, extraesophageal symptoms, symptom burden, and therapeutic agents) was used; subjects were asked to fill the questionnaire at the time of inclusion and 3, 6, and 12 months afterward. RESULTS A total of 162 infants and 42 children were included. pH-MII was performed in 15.4% and 57.4% of infants and children, respectively. All of the other subjects underwent pH-metry. Median RI was 2.0% (interquartile range 3.4) in infants and 1.7% (interquartile range 2.3) in children. RI was considered positive in 6.8% and 12.8% of infants and children, respectively. In infants, RI at baseline was significantly associated with symptom burden at baseline and at 3 and 12 months of follow-up. RI at baseline and reported GI symptoms at 3 months were also significantly associated. In infants and children using medication, symptom burden was significantly higher compared with those not using medication. This difference was found at baseline, after 3 and 12 months. CONCLUSIONS In infants, an initial high RI is associated with persistence of GI symptoms at 3 months and a higher burden of symptoms during the course of 1 year. In children there were no such findings.
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31
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Avdeev VG. [Some issues of the diagnosis and treatment of gastroesophageal reflux disease]. TERAPEVT ARKH 2015. [PMID: 28635804 DOI: 10.17116/terarkh20158710120-124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The clinical inefficacy of proton pump inhibitors (PPIs) is very frequently encountered in nonerosive gastroesophageal reflux disease (NERD) in particular. Postprandial acid pocket, weak-acid or alkaline reflux, etc. are one of the causes of resistance to antisecretory drugs. Alginates serve as a good alternative to PPIs in treating NERD and gastroesophageal reflux in children and pregnant women. The alginate test may help diagnose NERD.
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Affiliation(s)
- V G Avdeev
- Department of Internal Medicine, Faculty of Fundamental Medicine, M.V. Lomonosov Moscow State University, Moscow, Russia
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32
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Managing gastroesophageal reflux symptoms in the very low-birth-weight infant postdischarge. Adv Neonatal Care 2014; 14:381-91; quiz E1-2. [PMID: 25422924 DOI: 10.1097/anc.0000000000000141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Gastroesophageal reflux and gastroesophageal reflux disease symptoms are common challenges for very low-birth-weight infants (<1500 g). These symptoms frequently result in feeding difficulties and family stress. Management of symptoms across healthcare disciplines may not be based on current evidence, and inconsistency can result in confusion for families and delayed interventions. The feeding relationship between infant and caregivers may be impaired when symptoms are persistent and poorly managed. An algorithm for managing gastroesophageal reflux-like symptoms in very low-birth-weight infants (from hospital discharge to 12 months corrected age) was developed through the formation of a multidisciplinary community of practice and critical appraisal of the literature. A case study demonstrates how the algorithm results in a consistent approach for identifying symptoms, applying appropriate management strategies, and facilitating appropriate timing of medical consultation. Application to managing gastroesophageal reflux symptoms in the neonatal intensive care unit will be briefly addressed.
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33
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Tighe M, Afzal NA, Bevan A, Hayen A, Munro A, Beattie RM. Pharmacological treatment of children with gastro-oesophageal reflux. Cochrane Database Syst Rev 2014; 2014:CD008550. [PMID: 25419906 PMCID: PMC8947620 DOI: 10.1002/14651858.cd008550.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux (GOR) is a common disorder, characterised by regurgitation of gastric contents into the oesophagus. GOR is a very common presentation in infancy in both primary and secondary care settings. GOR can affect approximately 50% of infants younger than three months old (Nelson 1997). The natural history of GOR in infancy is generally that of a functional, self-limiting condition that improves with age; < 5% of children with vomiting or regurgitation continue to have symptoms after infancy (Martin 2002). Older children and children with co-existing medical conditions can have a more protracted course. The definition of gastro-oesophageal reflux disease (GORD) and its precise distinction from GOR are debated, but consensus guidelines from the North American Society of Gastroenterology, Hepatology and Nutrition (NASPGHAN-ESPGHAN guidelines 2009) define GORD as 'troublesome symptoms or complications of GOR.' OBJECTIVES This Cochrane review aims to provide a robust analysis of currently available pharmacological interventions used to treat children with GOR by assessing all outcomes indicating benefit or harm. SEARCH METHODS We sought to identify relevant published trials by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 5), MEDLINE and EMBASE (1966 to 2014), the Centralised Information Service for Complementary Medicine (CISCOM), the Institute for Scientific Information (ISI) Science Citation Index (on BIDS-UK General Science Index) and the ISI Web of Science. We also searched for ongoing trials in the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com).Reference lists from trials selected by electronic searching were handsearched for relevant paediatric studies on medical treatment of children with gastro-oesophageal reflux, as were published abstracts from conference proceedings (published in Gut and Gastroenterology) and reviews published over the past five years.No language restrictions were applied. SELECTION CRITERIA Abstracts were reviewed by two review authors, and relevant RCTs on study participants (birth to 16 years) with GOR receiving a pharmacological treatment were selected. Subgroup analysis was considered for children up to 12 months of age, and for children 12 months to 16 years of age, and for those with neurological impairment. DATA COLLECTION AND ANALYSIS Trials were critically appraised and data collected by two review authors. Risk of bias was assessed. Meta-analysis data were independently extracted by two review authors, and suitable outcome data were analysed using RevMan. MAIN RESULTS A total of 24 studies (1201 participants) contributed data to the review. The review authors had several concerns regarding the studies. Pharmaceutical company support for manuscript preparation was a common feature; also, because common endpoints were lacking, study populations were heterogenous and variations in study design were noted, individual drug meta-analysis was not possible.Moderate-quality evidence from individual studies suggests that proton pump inhibitors (PPIs) can reduce GOR symptoms in children with confirmed erosive oesophagitis. It was not possible to demonstrate statistical superiority of one PPI agent over another.Some evidence indicates that H₂antagonists are effective in treating children with GORD. Methodological differences precluded performance of meta-analysis on individual agents or on these agents as a class, in comparison with placebo or head-to-head versus PPIs, and additional studies are required.RCT evidence is insufficient to permit assessment of the efficacy of prokinetics. Given the diversity of study designs and the heterogeneity of outcomes, it was not possible to perform a meta-analysis of the efficacy of domperidone.In younger children, the largest RCT of 80 children (one to 18 months of age) with GOR showed no evidence of improvement in symptoms and 24-hour pH probe, but improvement in symptoms and reflux index was noted in a subgroup treated with domperidone and co-magaldrox(Maalox(®) ). In another RCT of 17 children, after eight weeks of therapy. 33% of participants treated with domperidone noted an improvement in symptoms (P value was not significant). In neonates, the evidence is even weaker; one RCT of 26 neonates treated with domperidone over 24 hours showed that although reflux frequency was significantly increased, reflux duration was significantly improved.Diversity of RCT evidence was found regarding efficacy of compound alginate preparations(Gaviscon Infant(®) ) in infants, although as a result of these studies, Gaviscon Infant(®) was changed to become aluminium-free and has been assessed in its current form in only two studies since 1999. Given the diversity of study designs and the heterogeneity of outcomes, as well as the evolution in formulation, it was not possible to perform a meta-analysis on the efficacy of Gaviscon Infant(®) . Moderate evidence indicates that Gaviscon Infant(®) improves symptoms in infants, including those with functional reflux; the largest study of the current formulation showed improvement in symptom control but was limited by length of follow-up.No serious side effects were reported.No RCTs on pharmacological treatments for children with neurodisability were identified. AUTHORS' CONCLUSIONS Moderate evidence was found to support the use of PPIs, along with some evidence to support the use of H₂ antagonists in older children with GORD, based on improvement in symptom scores, pH indices and endoscopic/histological appearances. However, lack of independent placebo-controlled and head-to-head trials makes conclusions as to relative efficacy difficult to determine. Further RCTs are recommended. No robust RCT evidence is available to support the use of domperidone, and further studies on prokinetics are recommended, including assessments of erythromycin.Pharmacological treatment of infants with reflux symptoms is problematic, as many infants have GOR, and little correlation has been noted between reported symptoms and endoscopic and pH findings. Better evidence has been found to support the use of PPIs in infants with GORD, but heterogeneity in outcomes and in study design impairs interpretation of placebo-controlled data regarding efficacy. Some evidence is available to support the use of Gaviscon Infant(®) , but further studies with longer follow-up times are recommended. Studies of omeprazole and lansoprazole in infants with functional GOR have demonstrated variable benefit, probably because of differences in inclusion criteria.No robust RCT evidence has been found regarding treatment of preterm babies with GOR/GORD or children with neurodisabilities. Initiation of RCTs with common endpoints is recommended, given the frequency of treatment and the use of multiple antireflux agents in these children.
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Affiliation(s)
- Mark Tighe
- Poole Hospital NHS Foundation TrustDepartment of PaediatricsLongfleet RoadPooleDorsetUKBH15 2JB
| | - Nadeem A Afzal
- University Hospital Southampton NHS Foundation TrustChild HealthTremona RoadSouthamptonHampshireUKSO16 6YD
| | - Amanda Bevan
- University Hospital Southampton NHS Foundation TrustDepartment of PharmacyTremona RoadSouthamptonHampshireUK
| | - Andrew Hayen
- University of TechnologyFaculty of HealthUltimoNSWAustralia2007
| | - Alasdair Munro
- Poole Hospital NHS Foundation TrustDepartment of PaediatricsLongfleet RoadPooleDorsetUKBH15 2JB
| | - R Mark Beattie
- University Hospital Southampton NHS Foundation TrustChild HealthTremona RoadSouthamptonHampshireUKSO16 6YD
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Ioan I, Poussel M, Coutier L, Plevkova J, Poliacek I, Bolser DC, Davenport PW, Derelle J, Hanacek J, Tatar M, Marchal F, Schweitzer C, Fontana G, Varechova S. What is chronic cough in children? Front Physiol 2014; 5:322. [PMID: 25221517 PMCID: PMC4148026 DOI: 10.3389/fphys.2014.00322] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/05/2014] [Indexed: 01/28/2023] Open
Abstract
The cough reflex is modulated throughout growth and development. Cough—but not expiration reflex—appears to be absent at birth, but increases with maturation. Thus, acute cough is the most frequent respiratory symptom during the first few years of life. Later on, the pubertal development seems to play a significant role in changing of the cough threshold during childhood and adolescence resulting in sex-related differences in cough reflex sensitivity in adulthood. Asthma is the major cause of chronic cough in children. Prolonged acute cough is usually related to the long-lasting effects of a previous viral airway infection or to the particular entity called protracted bacterial bronchitis. Cough pointers and type may orient toward specific etiologies, such as barking cough in croup or tracheomalacia, paroxystic whooping cough in Pertussis. Cough is productive in protracted bacterial bronchitis, sinusitis or bronchiectasis. Cough is usually associated with wheeze or dyspnea on exertion in asthma; however, it may be the sole symptom in cough variant asthma. Thus, pediatric cough has particularities differentiating it from adult cough, so the approach and management should be developmentally specific.
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Affiliation(s)
- Iulia Ioan
- Service D'explorations Fonctionnelles Pédiatriques, Hôpital D'enfants Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France
| | - Mathias Poussel
- Service Des Examens de la Fonction Respiratoire et de L'aptitude à L'exercice Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France ; EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine Vandoeuvre, France
| | - Laurianne Coutier
- EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine Vandoeuvre, France
| | - Jana Plevkova
- Department of Pathophysiology, Jessenius Faculty of Medicine, Comenius University Martin, Slovakia
| | - Ivan Poliacek
- Institute of Medical Biophysics, Jessenius Faculty of Medicine, Comenius University Martin, Slovakia
| | - Donald C Bolser
- Department of Physiological Sciences, University of Florida Gainesville, FL, USA
| | - Paul W Davenport
- Department of Physiological Sciences, University of Florida Gainesville, FL, USA
| | - Jocelyne Derelle
- Service de Médecine Infantile et de Génétique Clinique, Hôpital D'enfants Vandœuvre-lès-Nancy, France
| | - Jan Hanacek
- Department of Pathophysiology, Jessenius Faculty of Medicine, Comenius University Martin, Slovakia
| | - Milos Tatar
- Department of Pathophysiology, Jessenius Faculty of Medicine, Comenius University Martin, Slovakia
| | - François Marchal
- Service D'explorations Fonctionnelles Pédiatriques, Hôpital D'enfants Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France ; EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine Vandoeuvre, France
| | - Cyril Schweitzer
- Service D'explorations Fonctionnelles Pédiatriques, Hôpital D'enfants Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France ; EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine Vandoeuvre, France ; Service de Médecine Infantile et de Génétique Clinique, Hôpital D'enfants Vandœuvre-lès-Nancy, France
| | - Giovanni Fontana
- Department of Internal Medicine, University of Florence Florence, Italy
| | - Silvia Varechova
- Service D'explorations Fonctionnelles Pédiatriques, Hôpital D'enfants Centre Hospitalier Universitaire de Nancy, Vandoeuvre les Nancy, France ; EA 3450 DevAH - Laboratoire de Physiologie, Faculté de Médecine, Université Lorraine Vandoeuvre, France
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Abstract
Paediatric GERD is complicated to manage, as symptoms are diverse and often difficult to interpret. In infants, regurgitation is a common physiological condition. Nevertheless, when it occurs frequently (>4 times per day) and causes the infant distress, parents often seek medical help. In children 2-10 years of age, GERD is often considered to cause extra-oesophageal symptoms, despite the absence of hard evidence. Diagnostic investigations often lack solid validation and the signs and symptoms of GERD overlap with those of cow's milk protein allergy and eosinophillic oesophagitis. Reassurance, dietary treatment and positional adaptations are recommended for troublesome infant reflux. Anti-acid medication, mainly PPIs, is over-used in infants even though, in many children, reflux is not an acid-related condition. Moreover, evidence is increasing that PPIs cause adverse events such as gastroenteritis and respiratory tract infections. Management in children older than 10 years is similar to that in adults. Using prokinetics to treat nonerosive reflux disease remains only a promising theoretical concept, as no such molecule is currently available. Today, the adverse effects of each prokinetic molecule largely outweigh its potential benefit. Laparoscopic surgery is indicated in children who have life-threatening symptoms or in cases of drug dependence.
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Affiliation(s)
- Yvan Vandenplas
- Department of Pediatrics, UZ Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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Safety and efficacy of delayed release rabeprazole in 1- to 11-month-old infants with symptomatic GERD. J Pediatr Gastroenterol Nutr 2014; 58:226-36. [PMID: 24121146 DOI: 10.1097/mpg.0000000000000195] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM : The efficacy and safety of rabeprazole, a proton pump inhibitor, were studied in infants with gastroesophageal reflux disease (GERD). METHODS Infants ages 1 to 11 months, with symptomatic GERD resistant to conservative therapy and/or previous exposure to acid-suppressive medications, were screened. After scoring >16 on a GERD symptom score (Infant Gastroesophageal Reflux Questionnaire-Revised [I-GERQ]), 344 infants were enrolled in a 1- to 3-week open-label (OL) phase and received rabeprazole 10 mg/day. Following caregiver-rated clinical improvement during the OL phase, patients were randomized to placebo, rabeprazole 5 mg, or rabeprazole 10 mg in the ensuing 5-week double-blind (DB) withdrawal phase. Primary endpoints evaluated from DB baseline to the end of the DB withdrawal phase included frequency of regurgitation, weight-for-age z score, and daily and weekly GERD symptom scores. RESULTS Overall, 231 (86%) of the 268 randomized infants (placebo: 90; rabeprazole 5 mg: 90; rabeprazole 10 mg: 88) completed the study. Efficacy endpoints were similarly improved during the OL phase in all of the groups, and continued improving during the DB withdrawal phase with no difference between the placebo and combined rabeprazole groups. Mean decrease in frequency of regurgitation (-0.79 vs -1.20 times per day; P = 0.168), in I-GERQ-Revised scores (-3.6 [-25%] vs -3.9 points [-27%]; P = 0.960), in I-GERQ-Daily Diary scores (-1.87 [-19%] vs -1.85 [-19%]; P = 0.968), and increase in weight-for-age z scores (mean [standard deviation]: 0.11 [0.329] vs 0.14 [0.295]; P = 0.440) indicated equal improvement. Equal percentages (47%) reported adverse events in placebo and combined rabeprazole groups, with no new safety signals emerging. CONCLUSIONS In those infants with GERD who improved with rabeprazole during the OL phase, improvements in symptoms and weight were similar in those who continued rabeprazole and those withdrawn to placebo during a 5-week DB phase.
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Changes in prescription patterns of acid-suppressant medications by Belgian pediatricians: analysis of the national database, [1997-2009]. J Pediatr Gastroenterol Nutr 2014; 58:220-5. [PMID: 24464148 DOI: 10.1097/mpg.0b013e3182a3b04e] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of this study was to examine the trend in the prescribing of proton pump inhibitors (PPIs) and histamine 2-receptor antagonists (H2-RAs) for children in Belgium from 1997 to 2009 to encourage discussion regarding appropriate clinical use. METHODS Monthly claim-based data for PPIs and H2-RAs were obtained from the national health insurance database (Pharmanet 1997-2009). RESULTS The total monthly volume of all reimbursed antireflux medications, prescribed by Belgian pediatricians, increased 7-fold from 20,782 daily defined doses (DDDs) in January 1997 to 142,912 DDDs in June 2009. During this study period, reimbursed volume of H2-RAs increased from 2575 to 38,996 DDDs and of PPIs from 3472 to 103,926 DDDs per month. CONCLUSIONS PPI use has increased substantially in children. Its use does not seem to be commensurate with the prevalence of gastroesophageal reflux disease in children. This study encourages clinical discussion regarding well-considered use of these drugs in children.
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Abstract
BACKGROUND AND AIM Baclofen, a γ-aminobutyric acid receptor agonist, has been shown to reduce the episodes of gastroesophageal reflux (GER) by reducing the incidence of transient lower esophageal sphincter relaxations. Although baclofen has been shown to reduce reflux symptoms in adults, data in pediatric patients are limited. The aim of the study was to evaluate the efficacy of baclofen in children with refractory GER. METHODS Medical charts of patients 1 to 18 years of age treated with baclofen for persistent GER symptoms were reviewed retrospectively. Short-term (at first clinic visit) and long-term (12 months) clinical responses were assessed. RESULTS A total of 53 patients were included in the final analysis. The mean duration of illness was 1.5 years and the mean age was 6.1 years. All of the patients were taking either once- (53%) or twice-daily (47%) doses of proton pump inhibitors (PPIs) at the time of initiation of baclofen. Thirty-five (66%) patients experienced a significant reduction in clinical symptoms at their first follow-up visit. In the remaining 18 patients, however, baclofen was stopped because of either no response (n = 15) or adverse events (n = 3). A total of 27 patients continued treatment and were assessed for long-term response. Of those, 22 (81%) had a sustained response to baclofen at 12 months, whereas 5 (19%) lost response. We recognized no clinical characteristic differences between those with and without a response to baclofen at either time point. CONCLUSIONS Baclofen can be used as supplemental therapy to proton pump inhibitors in children with refractory GER; however, prospective trials are needed to further validate our results and assess safety.
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Efficacy and safety of rabeprazole in children (1-11 years) with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 2013; 57:798-807. [PMID: 23863328 DOI: 10.1097/mpg.0b013e3182a4e718] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Evaluate the efficacy and safety of rabeprazole in children, 1 to 11 years old, with endoscopically/histologically proven gastroesophageal reflux disease (GERD). METHODS Children were randomized to 0.5- or 1.0-mg/kg rabeprazole granule formulation for 12 weeks. The dose was further determined by weight: children 6 to 14.9 kg (low-weight cohort) received 5 or 10 mg and children ≥15 kg (high-weight cohort) received 10 or 20 mg. The primary endpoint was endoscopic/histologic healing at week 12 (defined as grade 0 on the Hetzel-Dent classification scale and/or grade 0 on the Histological Features of Reflux Esophagitis scale). RESULTS Overall, 81% (87/108) achieved endoscopic/histologic healing at week 12 with higher healing in the low-weight cohort (82% [5-mg dose], 94% [10-mg dose]) compared with high-weight cohort (76% [10-mg dose], 78% [20-mg dose]). There was a significant (P < 0.001) decrease in the mean Total GERD Symptoms and Severity score from 19.7 points (baseline) to 8.6 points (week 12), with 26% fewer children reporting GERD symptoms at week 12. The average frequency of symptoms per child decreased from 7.7 (week 1) to 4.7 (week 12). The GERD Symptom Relief score showed that 71% of children felt better, 81% were rated "good to excellent" on the Global Treatment Satisfaction scale by the investigator; 77% were rated "good to excellent" on the Clinical Global Impressions-Improvement scale by the parent/caregiver. The most common (>10%) treatment-emergent adverse events included cough and vomiting (14% each), abdominal pain (12%), and diarrhea (11%). CONCLUSIONS Rabeprazole was effective and safe in 1- to 11-year-old children with GERD.
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Hegar B, Satari DHI, Sjarif DR, Vandenplas Y. Regurgitation and gastroesophageal reflux disease in six to nine months old indonesian infants. Pediatr Gastroenterol Hepatol Nutr 2013; 16:240-7. [PMID: 24511520 PMCID: PMC3915725 DOI: 10.5223/pghn.2013.16.4.240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 12/04/2013] [Accepted: 12/09/2013] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Regurgitation is known to peak at the age of 3-4 months, with a sharp decrease around the age of 6 months. Little is known about the natural evolution of infants who still regurgitate after the age of 6 months. METHODS Hundred thirty-one infants older than 6 months regurgitating more than once a day were followed for a period of 3 months. RESULTS According to our data, gastroesophageal reflux disease (GERD) is seldom at this age. Most of the infants regurgitated 3 or more times/day and spit up an estimated volume of more than 15 mL. Eighty-five parents were educated regarding frequency of feeding. There were only 6 infants that still had frequent regurgitation (>3 times/day) despite an appropriate feeding schedule. The Infant GER Questionnaire score reached a score of 0 in 50% of the infants after one month of follow-up and in 81.9% at the third month of follow-up. There was an increase of the "weight for age z-score" trends in infants that still regurgitated at the end of follow-up and a declining z-score in infants that no longer regurgitated. An explanation may be that infants that regurgitate drink larger volumes than infants who do not regurgitate. Conservative treatment (reassurance, dietary treatment, behavioral advice) resulted in a significant better outcome than natural evolution. CONCLUSION Regurgitation that persisted after the age of 6 months, strongly decreased during a 3-month follow-up with conservative treatment. GERD is rare in this age group; therefore, anti-reflux medication is only seldom needed.
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Affiliation(s)
- Badriul Hegar
- Department of Child Health, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Debora Hindra I Satari
- Department of Child Health, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Damayanti R Sjarif
- Department of Child Health, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yvan Vandenplas
- Universitair Kinderziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Wu JF, Hsu WC, Tseng PH, Wang HP, Hsu HY, Chang MH, Ni YH. Combined multichannel intraluminal impedance and pH monitoring assists the diagnosis of sliding hiatal hernia in children with gastroesophageal reflux disease. J Gastroenterol 2013; 48:1242-1248. [PMID: 23397115 DOI: 10.1007/s00535-013-0750-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 01/04/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND The role of combined multichannel intraluminal impedance and pH monitoring (MII-pH) in diagnosing sliding hiatal hernia in gastroesophageal reflux disease (GERD) children remains unclear. We aimed to explore the clinical efficacy of MII-pH as a supplement diagnostic method for sliding hiatal hernia. METHODS A total of 104 symptomatic GERD children [mean ± standard deviation (SD) age = 4.5 ± 5.5 years] were recruited. All of them were diagnosed as GERD with and without sliding hiatal hernia by barium and/or esophagogastroduodenoscopy study. All subjects received 24 h MII-pH monitoring to test the efficacy of this new modality. RESULTS Sixteen children were diagnosed to have sliding hiatal hernia, and nine (56.3%) of them received fundoplication. None of non-hiatal hernia children were indicated for fundoplication [risk difference (RD) 0.56; P < 0.001]. Impedance probes detected more reflux episodes than pH-probe in the whole study population (mean ± SD = 62.1 ± 47.8 vs. 47.8 ± 48.1 episodes; P = 0.02, paired t test). Due to the presence of pH-only reflux, the reflux episodes detected by impedance probes is less than that by pH probe in sliding hiatal hernia children (mean ± SD = 49.2 ± 78.9 vs. 103.7 ± 60.4 episodes; P = 0.01, paired t test). Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 was more frequently noted in sliding hiatal hernia children than non-sliding hiatal hernia children (Odds ratio 58.33, P < 0.001). The sensitivity and specificity of this diagnostic tool to predict sliding hiatal hernia in GERD children are 93.8 and 79.6%, respectively. CONCLUSIONS Ratio of reflux episodes detected by pH-probe to that by impedance probes >1 demonstrated by MII-pH study is a good screening test of sliding hiatal hernia in GERD children.
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Affiliation(s)
- Jia-Feng Wu
- Department of Pediatrics, National Taiwan University Children's Hospital and College of Medicine, National Taiwan University, No. 8, Chung Shan South Road, Taipei, 100, Taiwan
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van der Pol RJ, Smits MJ, Venmans L, Boluyt N, Benninga MA, Tabbers MM. Diagnostic accuracy of tests in pediatric gastroesophageal reflux disease. J Pediatr 2013; 162:983-7.e1-4. [PMID: 23219449 DOI: 10.1016/j.jpeds.2012.10.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/23/2012] [Accepted: 10/16/2012] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To systematically review the literature evaluating the diagnostic accuracy of commonly used diagnostic tests over conventional history taking and physical examination in children ≤ 18 months and >18 months suspected of gastroesophageal reflux disease (GERD). STUDY DESIGN We searched Medline, Embase, and the Cochrane database for studies assessing the diagnostic accuracy of pH-metry, pH-impedance, esophagogastroscopy, barium contrast study, scintigraphy, and empirical treatment as diagnostic tools. Quality was assessed according to Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews criteria. RESULTS Of the 2178 studies found, 6 studies were included, containing 408 participants (age 1 month-13.6 years) and 145 controls (age 1 month-16.9 years). Studies included children with GERD symptoms; 1 included an atypical presentation. In all the studies, the diagnostic accuracy of pH-metry was investigated, and in 2 studies esophagogastroscopy was investigated as well. Sensitivity and specificity were calculated in 3 studies. The range of reported sensitivity and specificity was broad and unreliable because of poor methodological quality according to Quality Assessment of Studies of Diagnostic Accuracy Included in Systematic Reviews criteria and inadequate study design. CONCLUSION Diagnostic accuracy of tests in children suspected of GERD remains unclear and implications for practice are hard to give. There is an urgent need of well-designed randomized controlled trials where the effect of treatment according to specific signs and symptoms will be compared with the effect of treatment based on the results of additional diagnostic tests, for patient relevant outcomes.
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Affiliation(s)
- Rachel J van der Pol
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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Kearns GL, Blumer J, Schexnayder S, James LP, Adcock KG, Reed MD, Daniel JF, Gaedigk A, Paul J. Single-Dose Pharmacokinetics of Oral and Intravenous Pantoprazole in Children and Adolescents. J Clin Pharmacol 2013; 48:1356-65. [DOI: 10.1177/0091270008321811] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chung EY, Yardley J. Are there risks associated with empiric acid suppression treatment of infants and children suspected of having gastroesophageal reflux disease? Hosp Pediatr 2013; 3:16-23. [PMID: 24319831 DOI: 10.1542/hpeds.2012-0077] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND It has become common practice to empirically treat infants and children who have suspected gastroesophageal reflux disease by using acid-suppressive medications. However, evidence to support the effectiveness of these medications in the pediatric population is limited. With multiple studies in adult patients indicating increased risk of infection, we reviewed the literature to determine the association between acid-suppressive medications and serious adverse effects in infants and children. METHODS We conducted a PubMed search on the adverse effects of H2 antagonists and proton pump inhibitors in pediatric patients. The studies selected were original research and systematic reviews with control groups and study objectives evaluating the relationship between acid-suppressive medications and serious adverse effects (namely, infections). RESULTS Fourteen studies met our inclusion criteria. The majority of studies found a significant association between acid-suppressive medications and the risk of necrotizing enterocolitis, sepsis/bacteremia, pneumonia, and gastrointestinal infections in infants and children. CONCLUSIONS Given the questionable efficacy of H2 antagonists and proton pump inhibitors and the growing evidence of increased risk of serious infections, acid-suppressive medications should be used cautiously in infants and children suspected of having gastroesophageal reflux disease.
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Affiliation(s)
- Erica Y Chung
- The Warren Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island, USA.
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Martigne L, Delaage PH, Thomas-Delecourt F, Bonnelye G, Barthélémy P, Gottrand F. Prevalence and management of gastroesophageal reflux disease in children and adolescents: a nationwide cross-sectional observational study. Eur J Pediatr 2012; 171:1767-73. [PMID: 22903328 DOI: 10.1007/s00431-012-1807-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 07/18/2012] [Accepted: 07/20/2012] [Indexed: 01/10/2023]
Abstract
UNLABELLED This cross-sectional observational study aimed to determine the nationwide prevalence of gastroesophageal reflux disease (GORD) in French children and adolescents. Four hundred four general practitioners and 180 paediatricians compiled a register of all children and adolescents (n = 10,394, aged 0 to 17 years, mean 3.8 ± 5.6 years) who presented over two 3-day periods. For all children who, in the physician's opinion, showed symptoms of gastroesophageal reflux (GOR), a 24-item questionnaire covering the history and management of GOR was completed. Children with symptoms that impaired their daily lives were defined as having GORD, the remainder as having physiological GOR. Of the patients, 15.1 % showed GOR symptoms. Extrapolation to the overall French population yielded a prevalence of 10.3 % for GOR and 6.2 % for GORD. There was a significantly (p < 0.05) greater use of volume reduction or milk thickeners and dorsal positioning among infants with GORD versus physiological GOR. Significantly (p < 0.05) more of the infants and children with GORD received pharmacological therapy. The use of proton pump inhibitors increased with age but was significantly (p < 0.05) higher among those with GORD. CONCLUSIONS Ten percent of French children and adolescents show GOR symptoms and 6 % have GORD. Clinical presentation and treatment vary in different age groups, but those with GORD are more likely to require pharmacological treatment.
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Affiliation(s)
- Léonie Martigne
- Unité Inserm U995, Service de Gastroentérologie, Hépatologie et Nutrition Pédiatrique, Pôle Enfant, Hôpital Jeanne de Flandre, CHRU de Lille, Avenue Eugène Avinée, 59037 Lille Cedex, France
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Goldani HA, Nunes DL, Ferreira CT. Managing gastroesophageal reflux disease in children: The role of endoscopy. World J Gastrointest Endosc 2012; 4:339-46. [PMID: 22912907 PMCID: PMC3423514 DOI: 10.4253/wjge.v4.i8.339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 06/28/2012] [Accepted: 08/08/2012] [Indexed: 02/05/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a growing problem in the pediatric population and recent advances in diagnostics and therapeutics have improved their management, particularly the use of esophago-gastroduodenoscopy (EGD). Most of the current knowledge is derived from studies in adults; however there are distinct features between infant onset and adult onset GERD. Children are not just little adults and attention must be given to the stages of growth and development and how these stages impact the disease management. Although there is a lack of a gold standard test to diagnose GERD in children, EGD with biopsy is essential to assess the type and severity of tissue damage. To date, the role of endoscopy in adults and children has been to assess the extent of esophagitis and detect metaplastic changes complicating GERD; however the current knowledge points another role for the EGD with biopsy that is to rule out other potential causes of esophagitis in patients with GERD symptoms such as eosinophilic esophagitis. This review highlights special considerations about the role of EGD in the management of children with GERD.
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Affiliation(s)
- Helena As Goldani
- Helena AS Goldani, Daltro LA Nunes, Cristina T Ferreira, Department of Pediatrics and Gastroenterology Unit, Hospital de Clinicas de Porto Alegre, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, 90035-903 Porto Alegre-RS, Brazil
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Rippel SW, Acra S, Correa H, Vaezi M, Di Lorenzo C, Walker LS. Pediatric patients with dyspepsia have chronic symptoms, anxiety, and lower quality of life as adolescents and adults. Gastroenterology 2012; 142:754-61. [PMID: 22226783 PMCID: PMC3321087 DOI: 10.1053/j.gastro.2011.12.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/23/2011] [Accepted: 12/20/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Little is known about long-term health outcomes of children with dyspeptic symptoms. We studied the natural history of pediatric patients with dyspeptic symptoms, with and without histologic reflux, compared with healthy controls. METHODS We performed a prospective study of consecutive new patients, ages 8-16 years, who underwent evaluation for dyspepsia, including upper endoscopy. Patients were assigned to groups with histologic evidence of reflux esophagitis (n = 50), or normal histology results (n = 53). Healthy children were followed up as controls (n = 143). Patients and controls were evaluated 5-15 years later. They provided self-reports on severity of dyspeptic symptoms, use of acid suppression, quality of life, anxiety, and depression. RESULTS When the study began, the groups with histologic evidence of esophagitis and normal histologies did not differ in severity of dyspeptic symptoms, functional disability, or depression. After a mean 7.6-year follow-up period, each group had significantly lower quality-of-life scores and more severe dyspeptic symptoms and functional disability than controls, but did not differ significantly from each other; both groups were significantly more likely than controls to meet criteria for an anxiety disorder. At time of follow-up evaluation, use of acid-suppression medication was significantly greater in the group with histologic evidence for esophagitis, compared with patients who had normal histology findings when the study began. CONCLUSIONS Among pediatric patients with dyspepsia evaluated by endoscopy and biopsy, those with histologic evidence for esophagitis or normal histology findings are at increased risk for chronic dyspeptic symptoms, anxiety disorder, and reduced quality of life in adolescence and young adulthood.
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Affiliation(s)
- Sara W Rippel
- Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sari Acra
- Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hernán Correa
- Department of Pathology, Microbiology, and Immunology, Division of Pediatric Pathology, Vanderbilt University, Nashville, TN, USA
| | - Michael Vaezi
- Department of Medicine, Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Carlo Di Lorenzo
- Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Lynn S. Walker
- Department of Pediatrics, Division of Adolescent and Young Adult Heath, Vanderbilt University School of Medicine, Nashville, TN, USA
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Crump C, Winkleby MA, Sundquist J, Sundquist K. Gestational age at birth and risk of gastric acid-related disorders in young adulthood. Ann Epidemiol 2012; 22:233-8. [PMID: 22382080 DOI: 10.1016/j.annepidem.2012.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 01/09/2012] [Accepted: 02/03/2012] [Indexed: 01/11/2023]
Abstract
PURPOSE Preterm birth is associated with gastric acid-related disorders in infancy, but no investigators have examined this association beyond early childhood. We used antisecretory medication data to explore whether preterm birth is associated with gastric acid-related disorders in young adulthood. METHODS We conducted a national cohort study of 626,811 individuals born in Sweden in 1973 to 1979, followed up for antisecretory (proton pump inhibitor and H2-receptor antagonist) medication prescriptions from all outpatient and inpatient pharmacies nationwide from 2005 to 2009 (ages 25.5-37.0 years). We excluded individuals with congenital anomalies, and examined potential confounding by other comorbidities identified on the basis of oral anti-inflammatory or corticosteroid medication prescription. RESULTS Gestational age at birth was inversely associated with antisecretory medication prescription in young adulthood. Adjusted odds ratios for ≥1 antisecretory medication prescription/year were 3.38 (95% confidence interval [95% CI], 1.73-6.62) for individuals born at 22-27 weeks, 1.38 (95% CI, 1.19-1.60) for those born at 28-34 weeks, and 1.19 (95% CI, 1.06-1.32) for those born at 35-36 weeks, relative to those born full-term (37-42 weeks). Exclusion of individuals who were prescribed oral anti-inflammatory or corticosteroid medications (≥1/year) had little effect on these results. CONCLUSIONS These findings suggest that low gestational age at birth may be independently associated with an increased risk of gastric acid-related disorders in young adulthood.
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Affiliation(s)
- Casey Crump
- Department of Medicine, Stanford University, CA, USA.
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Poets CF, Brockmann PE. Myth: gastroesophageal reflux is a pathological entity in the preterm infant. Semin Fetal Neonatal Med 2011; 16:259-63. [PMID: 21664203 DOI: 10.1016/j.siny.2011.05.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is concern about possible consequences of gastroesophageal reflux (GER) in preterm infants. GER is perceived to be a frequent condition in these infants, often causing an exhaustive investigation and expensive therapy. We review current evidence for and against an association between GER and apnea, failure to thrive, wheezing and respiratory diseases. Although there are some limitations to the methodologies currently used for detecting GER, there is clearly a lack of unequivocal evidence supporting a causal relationship between GER and its assumed consequences, particularly in preterm infants. Despite physiologic data that stimulation of laryngeal efferents by GER may induce apnea, there is little evidence for a causal relationship between GER and apnea. Studies on preterm infants with failure to thrive have also not demonstrated an association between the latter and GER in most cases, and there is equally little evidence for a casual relationship with respiratory problems. Therefore, we believe that GER in preterm infants is only rarely associated with serious consequences and existing evidence does not support the widespread use of anti-reflux medications for treatment of these signs in this age group. An improvement of methods to identify the few preterm infants at risk for developing serious consequences of GER is urgently needed.
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Affiliation(s)
- Christian F Poets
- Department of Neonatology, University Children's Hospital, Tübingen, Germany.
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Abstract
OBJECTIVES The relation between gastroesophageal reflux disease (GERD) and maternal psychopathology as well as the role of impairments in mother-child interactions in the perpetuation of feeding problems in children with GERD was previously implicated but not confirmed. The present study aimed to study the relation between maternal psychopathology and feeding problems in children with GERD and the effects of GERD on the psychomotor development of children. SUBJECTS AND METHODS The case group included 39 children with GERD and their mothers and the comparison group included 39 healthy children and their mothers. The groups were matched for age, gestational age, socioeconomic status, and sex. Scales used for the psychiatric assessment of mothers were the Beck Anxiety Inventory, Hamilton Rating Scale for Depression, Eating Attitudes Test, and Experiences in Close Relationships-Revised. The children's developmental levels were assessed by the Brunet-Lezine Revised test. RESULTS Maternal Beck Anxiety Inventory, Hamilton Rating Scale for Depression, Eating Attitudes Test, and Experiences in Close Relationships-Revised scores were significantly higher in the case group. Forced feeding and maternal thoughts of the child's feeding as insufficient were associated with a high level of maternal attachment-related anxiety and avoidance. Children with GERD had significantly lower Brunet-Lezine-Revised scores. CONCLUSIONS Maternal psychopathology, especially insecure attachment, may play a role in the feeding problems in children with GERD. Children with GERD should be examined for maternal psychopathology and feeding problems so that maladaptive feeding behaviors can receive appropriate intervention before the development of negative reinforcement to feeding. The psychomotor development of children should be kept in mind.
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