Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

Vandenplas, Yvan; Rudolph, Colin D.; Lorenzo, Carlo Di; Hassall, Eric; Liptak, Gregory S.; Mazur, Lynnette J; Sondheimer, Judith M.; Staiano, Annamaria; Thomson, Mary; Veereman-Wauters, G.; Wenzl, Tobias G.

doi:10.1097/mpg.0b013e3181b7f563

Cited by 677 publications

(934 citation statements)

References 721 publications

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“…MII/pH is superior to pH monitoring alone for the evaluation of a temporal relation between symptoms and reflux episodes. 3,4 In children, proton pump inhibitors (PPIs) have been shown to be effective and safe for short-term treatment of erosive esophagitis and GERD symptoms that are refractory to other drugs. 4,5 Studies in adults and children have reported that in comparison with H2-receptor antagonists (H2RAs), PPIs results in higher and faster rates of healing of erosive esophagitis compared with H2RAs.…”

Section: Introductionmentioning

confidence: 99%

Impact of antisecretory treatment on respiratory symptoms of gastroesophageal reflux disease in children

Ummarino

Miele

Masi

et al. 2012

Diseases of the Esophagus

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The effect of antisecretory treatment on extraesophageal symptoms of gastroesophageal reflux disease was evaluated. Seventy-eight children presenting with typical and extraesophageal symptoms of gastroesophageal reflux disease underwent a multichannel intraluminal impedance and pH monitoring (MII/pH). Children with a positive MII/pH were randomly treated with proton pump inhibitors (PPIs) or histamine H(2) -receptor antagonists (H(2) RAs) during 3 months. At the end of the treatment period, all patients were recalled. A second treatment period of 3 months was given to those patients who were not symptom-free after 3 months. Thirty-five of the forty-one (85.4%) children with a pathologic MII/pH presented with extraesophageal symptoms and were treated with PPIs (omeprazole; n:19) or H(2) RAs (ranitidine; n:16) for 12 weeks. After 3 months, 11/19 (57.9%) PPI-treated patients had a complete resolution of symptoms; 6/8 nonresponders were treated with PPI for another 3 months and became all symptom-free. The other two underwent a Nissen fundoplication. Only 5/16 (31.2 %) patients treated with H(2) RAs had a complete resolution of symptoms after 3 months; 1/11 was treated again with H(2) RAs during 3 months, and 10/11 were changed to PPIs. In 3/10, a partial resolution of symptoms was achieved, while in 7/10, a complete remission was obtained (P < 0.05). Antisecretory reflux treatment improves extraesophageal reflux symptoms. The efficacy of PPIs is superior to that of H(2) RAs in these children.

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Section: Introductionmentioning

confidence: 99%

Impact of antisecretory treatment on respiratory symptoms of gastroesophageal reflux disease in children

Ummarino

Miele

Masi

et al. 2012

Diseases of the Esophagus

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“…The outcomes were analyzed after a median of 39 days on PPI therapy, which coincides with the expected PPI efficacy time frame of ~4 weeks. 4 These pilot data also suggest the potential for improved safety with GGD of PPIs, as there were fewer adverse effects in the GGD arm compared with the CD arm. We detected a significant difference in the total score of the SN-5 questionnaire between arms ( Table 2).…”

Section: Discussionmentioning

confidence: 85%

Novel Implementation of Genotype‐Guided Proton Pump Inhibitor Medication Therapy in Children: A Pilot, Randomized, Multisite Pragmatic Trial

Cicali

Blake

Gong

et al. 2018

Clinical Translational Sci

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The efficacy of proton pump inhibitor (PPI) medications is highly dependent on plasma concentrations, which varies considerably due to cytochrome P450 ( CYP2C19 ) genetic variation. We conducted a pragmatic, pilot study of CYP2C19 genotype‐guided pediatric dosing of PPI medications. Children aged 5–17 years old with gastric‐acid‐related conditions were randomized to receive either conventional dosing of a PPI or genotype‐guided dosing for a total of 12 weeks. Sixty children (30 in each arm) were enrolled and had comparable baseline characteristics. The mean daily omeprazole equivalent dose prescribed to participants across metabolizer phenotype groups was significantly different in the genotype‐guided dosing arm ( P < 0.001), but not in the conventional dosing arm. Prescribers waited for the genotype result before prescribing the PPI medication for 90% of the participants in the genotype‐guided dosing arm. The number of participants who reported an infection was marginally lower in genotype‐guided dosing vs. conventional dosing (20% vs. 44%; P = 0.07). Sinonasal symptoms were higher in the conventional dosing arm as compared with genotype‐guided dosing arm: (2.6 (2.0, 3.4) vs. 1.8 (1.0, 2.3), P = 0.031). CYP2C19 genotype‐guided PPI therapy is feasible in a clinical pediatric setting, well accepted by providers, resulted in differential PPI dosing, and may reduce PPI‐associated infections. A future large scale randomized clinical trial of CYP2C19 genotype‐guided pediatric dosing of PPI medications in children is warranted.

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“…According to literature, GER is not the most frequent cause of apnea or apparent life-threatening events (ALTEs), but when this possibility is considered, it is advisable to carry out a prolonged esophageal pH monitoring study with polysomnography and, when available, multichannel intraluminal esophageal impedanciometry. 4,14,[18][19][20][21][22][23] Literature regarding the association of GERD with apnea, respiratory pauses, ALTE, or sudden infant death is very conflictive. This could be explained by the different criteria used to define respiratory arrest and the different methods of reflux evaluation, as well as the different populations.…”

Section: Discussionmentioning

confidence: 99%

“…14 When used in highly select cases, reflux was clearly associated with central and obstructive pathological apneas, but none of these studies has conclusively shown the relationship of cause and effect between GER and pathological apnea. 4,14,[18][19][20][21] To define a high RI for infants we used parameters used in many other studies. 15 RI higher than 10% was found in 45% of the infants in this study.…”

Section: Discussionmentioning

confidence: 99%

“…When the pH in the distal esophagus was below 4 during a period ≥15 seconds, the GER was considered acid as per the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition criteria. 1,14 The esophageal pH monitoring parameters were: reflux index (RI) as percentage of time with esophageal pH < 4.0; number of episodes during the study; number of episodes lasting more than 5 minutes duration; duration of the longest reflux episode; temporal association between signs and symptoms with reflux episodes; and ZMD index (median duration of reflux episodes occurred during the sleep time more than 2 hours after feeding). All the tests were interpreted by the same professional who considers it pathological when at least one of the following situations occur: at least one episode lasting more than 20 minutes; temporal association of more than 50% of the signs and symptoms linked to acid GER episodes; RI above 10%; 15 and ZMD above 3.8 minutes/episode.…”

Section: Methodsmentioning

confidence: 99%

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Infants under 3 months old with cyanosis at the emergency room: could it be gastroesophageal reflux?

Epifânio

Cassiano

et al. 2013

Dis Esophagus

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The aim of this study is to describe the prevalence of gastroesophageal reflux disease (GERD) in infants under 3 months old with a history of cyanotic episodes, who were examined at the emergency room of a university hospital. This descriptive study reviews reports of esophageal pH monitoring from a pediatric gastroenterology service over a period of 5 years. The following data were collected: age, sex, pediatric as well as other specialists' evaluations, and the esophageal pH monitoring reports. This study included 67 infants with a history of cyanotic episodes, with no primary cause determined by pediatrician and pediatric specialists' evaluations, who underwent esophageal pH monitoring. The infants were 6-90 days old, 41 (61.2%) of them male. Fifty infants (74.6%) had at least one esophageal pH monitoring parameter above the normal limit. ZMD index was abnormal in 32 cases (48%) and reflux index was abnormal in 31 cases (46%). When other common causes of cyanosis have been ruled out, a significant proportion of infants presenting cyanosis have abnormal pH study, suggesting the role of GERD in cyanosis. The authors highlight that reflux index is not enough to conclude whether a pH study is normal or not. The ZMD index and the presence of episodes longer than 20 minutes are also important parameters for GERD diagnosis.

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Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

Cited by 677 publications

References 721 publications

Impact of antisecretory treatment on respiratory symptoms of gastroesophageal reflux disease in children

Impact of antisecretory treatment on respiratory symptoms of gastroesophageal reflux disease in children

Novel Implementation of Genotype‐Guided Proton Pump Inhibitor Medication Therapy in Children: A Pilot, Randomized, Multisite Pragmatic Trial

Infants under 3 months old with cyanosis at the emergency room: could it be gastroesophageal reflux?

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