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[Gastroesophageal reflux in infants: myths and realities]
1Département de pédiatrie, faculté de médecine Pierre-et-Marie-Curie, université Pierre-et-Marie-Curie Paris6, hôpital Armand-Trousseau, 75571 Paris cedex 12, France.
Insights
Gastroesophageal reflux (GER) in infants is common, but diagnosing GER disease is challenging. Current diagnostic tests and treatments for infant GER require further clarification and may be overprescribed.
Area of Science:
- Pediatric Gastroenterology
- Infant Health
- Digestive Disorders
Context:
- Gastroesophageal reflux (GER) is prevalent in infants, yet differentiating it from GER disease presents diagnostic difficulties.
- Clinical symptoms like vomiting and respiratory issues do not consistently correlate with reflux episodes, complicating diagnosis.
- Premature infants often experience reflux, but its link to apnea is poorly understood.
Purpose:
- To review the diagnostic challenges and treatment uncertainties surrounding gastroesophageal reflux disease (GERD) in infants.
- To evaluate the efficacy of current diagnostic methods, including pH monitoring and impedance measurements.
- To discuss the appropriate use of pharmacological and non-pharmacological interventions for infant GERD.
Summary:
- Distinguishing GER from GER disease in infants is difficult, with poor correlation between symptoms and reflux episodes.
- Diagnostic tests like pH monitoring have overlapping indices, and impedance's role in non-acid reflux harm is unclear.
- Treatment, particularly overprescription of medications, raises concerns regarding indications and efficacy, with non-pharmacological methods recommended first-line.
Impact:
- Highlights the need for clearer diagnostic criteria and evidence-based treatment guidelines for infant GERD.
- Emphasizes the potential for overprescription and the importance of considering non-pharmacological interventions.
- Underscores the variability in proton pump inhibitor efficacy due to patient age and genetic factors, necessitating cautious use.
Abstract:
Gastroesophageal reflux (GER) is a common problem in infants but the distinction between GER and GER disease remains difficult. Clinical manifestations such as vomiting, poor weight gain, respiratory disorders, and apneas do always not correlate with the demonstration of reflux episodes. Premature infants frequently suffer from reflux but correlations with apneas are also poor. Esophagitis is a complication suggested in infants experiencing pain but reflux by itself can induce pain as well. The "gold" diagnosis test is pH recording; however, overlap between normal and abnormal indices is obvious. Impedance measurement demonstrates more reflux episodes but non-acid reflux harm is not established. GER disease is probably self-limited in most infants, although it is impossible to predict whether some of them continue to have GER in adult life. The treatment raises doubts concerning indications and efficacy. Overprescription is frequent in infants with regurgitations. Nonpharmacological treatment - small-volume thickened milk and correct positioning - should be the first-line treatment. Prokinetic drugs have not proved their efficacy. Among anti-acid drugs, proton pump inhibitors are the best choice, but their indications are not very clearly established for infants. On the other hand, considerable variations of their metabolism due to the patients' age and genetic factors can explain variations in therapeutic effects.
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