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Management of paediatric GERD

Nature Reviews Gastroenterology & Hepatology volume 11, pages 147–157 (2014)Cite this article

Subjects

Key Points

  • GERD in infants and young children differs from that in children older than 10 years; GERD in older children should be diagnosed and treated according to guidelines for adults

  • Reassurance, but mainly dietary treatment and to some extent positional adaptations, are effective in distressed infants presenting with troublesome frequent regurgitation; PPIs are not effective in infants for this indication

  • Inconsolable crying and irritability are not decreased by anti-acid medication; therefore, these symptoms do not seem to be caused by acid reflux

  • An effective and safe prokinetic drug that improves oesophageal clearance, increases lower oesophageal sphincter pressure or decreases inappropriate sphincter relaxations and/or improves gastric emptying is of potential clinical interest

  • In infants, symptoms of GERD, eosinophilic oesophagitis and cow's milk protein allergy can be quite similar

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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Figure 1: Practical algorithm for the management of infant regurgitation.
Figure 2: Positional adaptations for paediatric GERD.

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  1. Department of Pediatrics, UZ Brussel, Laarbeeklaan 101, Brussels, 1090, Belgium

    Yvan Vandenplas

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Y. Vandenplas acts as a consultant for Biocodex and United Pharmaceuticals.

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Vandenplas, Y. Management of paediatric GERD. Nat Rev Gastroenterol Hepatol 11, 147–157 (2014). https://doi.org/10.1038/nrgastro.2013.199

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