Managing gastro-oesophageal reflux disease in children

Area of Science:

• Pediatric Gastroenterology
• Digestive Health
• Infant and Child Medicine

Background:

• Gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD) are more prevalent in infants than older individuals.
• Infant GOR/GORD is associated with immature esophageal and gastric functions and high liquid intake.
• Genetic factors may play a role in some familial cases.

Purpose of the Study:

• To review the prevalence, symptoms, and treatment of GOR and GORD in infants and children.
• To evaluate the efficacy and safety of various treatment modalities, including lifestyle changes and pharmacotherapy.
• To provide guidance on appropriate management strategies based on age and disease severity.

Main Methods:

• Literature review of studies on infant and pediatric GOR and GORD.
• Analysis of clinical symptoms, diagnostic approaches, and treatment outcomes.
• Comparison of the effectiveness of different medications like PPIs, H2RAs, and prokinetics.

Main Results:

• Infant GOR/GORD symptoms (regurgitation, vomiting) typically resolve by age 3.
• Lifestyle modifications and thickened feeds are effective for mild GORD in infants.
• Proton pump inhibitors (PPIs) demonstrate proven efficacy and good tolerance in infants and children with moderate to severe GORD, especially with esophagitis.
• Dosages for PPIs require adaptation in neonates and children under 10.
• Fundoplication should ideally be delayed until after age 2-3 years.

Conclusions:

• GOR and GORD management in children requires age- and severity-specific approaches.
• PPIs are effective and well-tolerated treatments for moderate to severe pediatric GORD.
• Conservative measures are recommended for mild cases, while surgical intervention should be considered cautiously.