A critical appraisal of current management practices for infant regurgitation - recommendations of a working party

Vandenplas, Yvan; Belli, Dominique Charles; Benhamou, PH; Cadranel, Samy; Cézard, J.P.; Cucchiara, Salvatore; Dupont, Christophe; Fauré, Christophe; Gottrand, Frédéric; Hassall, Eric; Heymans, H. S. A.; Kneepkens, C. M. F.; Sandhu, Bhupinder

doi:10.1007/s004310050613

Cited by 95 publications

(131 citation statements)

References 111 publications

(104 reference statements)

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“…Although the precise prevalence of reflux in children is not known, it is estimated that 1 in 5 children may present with the symptoms of reflux [7]. About 4−10% of patients who complain about laryngeal diseases are diagnosed with LPR [8]. Patients with reflux have the impaired physiological barriers that protect from acid gastric contents (upper and lower sphincter of the oesophagus, oesophageal mucosa, peristalsis, as well as saliva and gravity), acid gastric contents damage epithelium of the larynx and pharynx [9].…”

Section: Discussionmentioning

confidence: 99%

Chronic Cough as a Symptom of Laryngopharyngeal Reflux—Two Case Reports

Kopka¹,

Małecka²,

Stelmach³

2015

Advances in Respiratory Medicine

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Laryngopharyngeal reflux (LPR ) is a complex of symptoms caused by the backflow of gastric contents into the larynx, pharynx, nasopharynx, sinuses and even to the middle ear space.The symptomatology of LPR includes: chronic cough, hoarseness, throat clearing, laryngitis, "globus pharyngeus", swallowing disturbances, postnasal drip, "fetor ex ore". In the article, the authors present two boys with chronic cough, in one of them the asthma was suspected and antiasthmatic treatment was administrated; in our patients according to the 24-hour pharyngeal pH-metry LPR was diagnosed. The aim of this study was to emphasise that pediatricians should be able to recognise symptoms of LPR. The appropriate diagnosis and treatment leads the symptoms to subside.

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Section: Discussionmentioning

confidence: 99%

Chronic Cough as a Symptom of Laryngopharyngeal Reflux—Two Case Reports

Kopka¹,

Małecka²,

Stelmach³

2015

Advances in Respiratory Medicine

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“…Overall incidence of the disease has been reported to be ∼11.2%, but differences in rates of diagnosis have been reported. 1 -3 Consensus-based guidelines for the management of GER were developed in 1997 by the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) working group 4 and in 2001 by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN). 5 In 2009, ESPGHAN and NASPGHAN combined to publish guidelines 6 that were endorsed by the American Academy of Pediatrics in 2013.…”

Section: What This Study Addsmentioning

confidence: 99%

Use of Gastroesophageal Reflux Medications in Premature Infants After NICU Discharge

et al. 2016

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OBJECTIVES: To describe the epidemiology and management of gastroesophageal reflux (GER) medications started in the first year of life for premature infants. METHODS:Retrospective review of a cohort of infants ≤35 weeks' gestation presenting for care by 168 days of age to a 30-site network between 2005 and 2009 (n = 2217) and followed to 3 years of age. Medication frequency, types, and duration of use were assessed. Logistic regression identified factors associated with treatment.RESULTS: Thirty-seven percent (812) were prescribed GER medications with 77% begun after NICU discharge. Ninety percent (727) received histamine-2 receptor antagonists, 33% (269) proton pump inhibitors, 22% (182) prokinetics; 40% (325) received >1 medication. Outpatient medication was initiated at 95 ± 69 days of life for total of 294 ± 249 days (interquartile ratio: 117-359). Feeding issues (adjusted odds ratio [aOR] 2.05, 95% confidence interval [CI]: 1.24-3.39) were associated with outpatient initiation. Forty-three percent (322) of infants started before 6 months were still on at 1 year of age associated with gestational age <32 weeks (aOR 1.76, 95% CI: 1.16-2.67), chronic lung disease (aOR 2.59, 95% CI: 1.29-5.22), and reactive airways disease (aOR 1.67, 95% CI: 1.05-2.65). CONCLUSIONS:Of the 37% of the cohort on GER medications, 77% were started after NICU discharge with prolonged use of medications. Feeding difficulties were associated with starting medication and markers of chronic lung disease with continuation of treatment. With uncertain evidence of efficacy, use of these medications in a high-risk population should be carefully evaluated.

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“…It has been observed in several studies, that just by reassuring the parents and giving them some very practical advice on how to feed the infant is helpful (6,7). The effects of parental reassurance have been suggested by many placebo controlled studies to show similar efficacies between the placebo and the tested intervention (6,7). If simple reassurance fails, dietary intervention is recommended, including restriction of the volume in overfed babies, and change to a thickened 'antiregurgitation' formula (5-7).…”

Section: Group 1: Uncomplicated Reflux -mentioning

confidence: 99%

Diagnosis and Treatment of Gastroesophageal Reflux Disease in Infants and Children

Vandenplas

1999

Canadian Journal of Gastroenterology and Hepatology

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Gastroesophageal reflux is a frequent, nonspecific phenomenon in infants and children. The recommended approach for infants with uncomplicated regurgitation is the reassurance of the parents about the physiological nature of excessive regurgitation, and if necessary, completed with dietary recommendations for formula-fed infants. If, despite these efforts, the symptoms persist, the administration of prokinetics such as cisapride is recommended before investigations such as esophageal pH monitoring are begun. Cisapride is the drug of choice because it has the best efficacy and safety profile. In infants and children presenting with symptoms that suggest esophagitis, endoscopy of the upper gastrointestinal tract is recommended. If there is severe esophagitis, acid suppression with H2receptor antagonists or proton pomp inhibitors is recommended, eventually in combination with prokinetics. In life-threatening situations, or in patients who are resistant to or dependent on acid suppressive medication, a surgical procedure such as laparoscopic Nissen should be considered.Esophageal pH monitoring is recommended to document gastroesophageal reflux disease in children presenting with unusual presentations such as chronic respiratory disease. Treatment consists of prokinetics and/or acid suppressive drugs, and surgery should be considered in many of these patients.

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A critical appraisal of current management practices for infant regurgitation - recommendations of a working party

Cited by 95 publications

References 111 publications

Chronic Cough as a Symptom of Laryngopharyngeal Reflux—Two Case Reports

Chronic Cough as a Symptom of Laryngopharyngeal Reflux—Two Case Reports

Use of Gastroesophageal Reflux Medications in Premature Infants After NICU Discharge

Diagnosis and Treatment of Gastroesophageal Reflux Disease in Infants and Children

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