Efficacy and safety of medical and nutritional management of gastroesophageal reflux in formula-fed infants: a narrative review

Abstract

Purpose of reviewThe prescription of proton pump inhibitors has an increasing trend, despite that guidelines recommend nutritional management as first-line management. A thickened antiregurgitation formula is recommended in formula-fed infants. In this review we focus on the novel insights in management of formula-fed infants with gastroesophageal reflux disease (GERD). Recent findingsNew data are limited. Concerning thickened antiregurgitation formula, locust bean gum has been the most studied and has limited adverse effects. However, positive results were also obtained with pectin. The effect of pro-and prebiotics on regurgitation is unclear. The overlap between cow's milk allergy and gastroesophageal reflux remains a challenge. SummaryVery limited new data were published during the last 18 months. Thickened antiregurgitation formula is the first-line approach in formula-fed infants with GERD. No specific thickening agent can be recommended because of lack of comparative trials. Proton pump inhibitors are over prescribed in infants.

Digestive Tolerance and Safety of an Anti-Regurgitation Formula Containing Locust Bean Gum, Prebiotics and Postbiotics: A Real-World Study

“…Therefore, FGIDs and GI discomfort are common reasons for pediatric consultation, with repeated medical visits, prescriptions of largely ineffective pharmacological treatments, and the purchase of over-the-counter remedies, resulting in a significant financial burden for families and healthcare systems [ 4 8 9 10 ]. Moreover, some of these medications may be associated with adverse effects, most commonly GI dysbiosis and small bowel bacterial overgrowth, associated with the use of proton pump inhibitors [ 4 10 ].…”

“…To address the global issues associated with FGIDs, early management with parental education, reassurance, and nutritional advice (feeding technique, feed volume and frequency, and the importance of avoiding overfeeding) are now the recommended first-line strategies, rather than medical interventions [ 8 10 11 12 ]. For non-exclusively breastfed infants with regurgitation, expert guidelines recommend the use of thickened formulas as a first-line nutritional management option to reduce the frequency and severity of symptoms [ 12 ].…”

“…For non-exclusively breastfed infants with regurgitation, expert guidelines recommend the use of thickened formulas as a first-line nutritional management option to reduce the frequency and severity of symptoms [ 12 ]. These anti-regurgitation (AR) formulas may contain a range of thickening agents to increase viscosity, including starch-based thickeners (e.g., corn or rice starch) or soluble fiber-based thickeners, such as pectin and locust bean gum (LBG) [ 10 13 ]. Thus, LBG is a safe and effective thickening agent [ 10 14 15 16 17 ].…”

“…These anti-regurgitation (AR) formulas may contain a range of thickening agents to increase viscosity, including starch-based thickeners (e.g., corn or rice starch) or soluble fiber-based thickeners, such as pectin and locust bean gum (LBG) [ 10 13 ]. Thus, LBG is a safe and effective thickening agent [ 10 14 15 16 17 ]. In addition, in vitro studies have indicated that LBG has a lower caloric value and higher viscosity than starch-based thickeners, because it remains unaffected by pH and is resistant to digestion by salivary amylases [ 10 13 ].…”

“…Thus, LBG is a safe and effective thickening agent [ 10 14 15 16 17 ]. In addition, in vitro studies have indicated that LBG has a lower caloric value and higher viscosity than starch-based thickeners, because it remains unaffected by pH and is resistant to digestion by salivary amylases [ 10 13 ].…”