Spitting up is a normal occurrence for young infants — as long as a child is growing well and not developing other problems, such as breathing difficulties, the problem will resolve on its own without treatment. But how can you determine if your patient has gastroesophageal reflux disease (GERD)? New expert guidelines draw on the latest research findings to help advise specialists and primary care providers on the evaluation and treatment of GERD in infants and children.
“Over the last 10 years, there has been an explosion of advances not only in our understanding the pathophysiology of reflux, but also in the diagnostic tests to evaluate reflux and problems that masquerade as reflux,” she explains. “In prior guidelines, the focus was on acid-related disease and treatment with acid suppression. We now know that gastroesophageal reflux, particularly in infants and young children, is often non-acidic, so treating patients with acid suppression is ineffective. This is a true paradigm shift.” Here, Rosen shares some highlights that every pediatrician should know.
Gastroesophageal reflux disease (GERD)—in which gastric acid flows upward out of the stomach into the esophagus—is one of the most common diagnoses seen in the pediatric gastroenterology clinic and causes a variety of symptoms such as heartburn, chest pain and vomiting. Patients with GERD also are at risk for atypical symptoms such as cough, wheezing and pneumonias. One of the proposed reasons for this is that stomach contents are refluxed into the mouth and are then aspirated into the airway.
Proving that aspiration is actually happening, however, is difficult. For this reason, children with GERD are often empirically put on prescription antacids such as proton pump inhibitors (PPIs) to try to alleviate their lung symptoms. Unfortunately, these medications have been associated with an increased risk of respiratory infections, which may make a child’s respiratory symptoms worse rather than better. …Read More