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Gastroesophageal reflux in infants and children
1University of Kansas School of Medicine-Wichita, 67214-3199, USA.
Insights
Gastroesophageal reflux in infants is common and resolves by 12 months with conservative care. Gastroesophageal reflux disease (GERD) is more serious, requiring medical evaluation and potential medication.
Area of Science:
- Pediatrics
- Gastroenterology
Background:
- Gastroesophageal reflux is a frequent, self-limiting condition in infants, typically resolving within 6-12 months.
- Conservative management includes thickened feedings, positioning, and parental reassurance.
Purpose of the Study:
- To differentiate between common gastroesophageal reflux and gastroesophageal reflux disease (GERD) in infants.
- To outline diagnostic and management strategies for GERD.
Main Methods:
- Review of differential diagnoses for infant GERD, including allergies and various systemic diseases.
- Discussion of pharmacologic interventions for GERD, such as prokinetic agents and H2 antagonists.
Main Results:
- GERD necessitates medical management and diagnostic workup, unlike typical reflux.
- Pharmacologic options include metoclopramide, cisapride, cimetidine, and ranitidine for esophagitis.
- Cisapride use in pediatric GERD is supported by recent studies but not widely available in the US.
Conclusions:
- Accurate diagnosis is crucial to distinguish self-limited reflux from GERD.
- Appropriate medical and diagnostic interventions are key for managing GERD in infants.
Abstract:
Gastroesophageal reflux is a common, self-limited process in infants that usually resolves by six to 12 months of age. Effective, conservative management involves thickened feedings, positional treatment, and parental reassurance. Gastroesophageal reflux disease (GERD) is a less common, more serious pathologic process that usually warrants medical management and diagnostic evaluation. Differential diagnosis includes upper gastrointestinal tract disorders; cow's milk allergy; and metabolic, infectious, renal, and central nervous system diseases. Pharmacologic management of GERD includes a prokinetic agent such as metoclopramide or cisapride and a histamine-receptor type 2 antagonist such as cimetidine or ranitidine when esophagitis is suspected. Although recent studies have supported the cautious use of cisapride in childhood GERD, the drug is currently not routinely available in the United States.