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Updated: May 6, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Gastroesophageal reflux disease: exaggerations, evidence and clinical practice
Cristina Targa Ferreira1, Elisa de Carvalho2, Vera Lucia Sdepanian3
1Pediatric Gastroenterology Service, Hospital da Criança Santo Antônio, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil; Pediatrics Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil.
Insights
Diagnosis and treatment of pediatric gastroesophageal reflux disease (GERD) lack evidence, leading to overuse of tests like abdominal ultrasonography and medications such as proton-pump inhibitors (PPIs). Conservative approaches are recommended.
Area of Science:
- Pediatric Gastroenterology
- Clinical Evidence Review
Background:
- Gastroesophageal reflux disease (GERD) in children presents diagnostic and therapeutic challenges.
- Uncertainty exists regarding the association between GERD and cow's milk protein allergy (CMPA), the utility of abdominal ultrasonography, and the overuse of proton-pump inhibitors (PPIs).
Purpose of the Study:
- To review current scientific evidence for diagnosing and treating GERD in pediatric populations.
- To clarify ambiguities surrounding GERD management in children.
Main Methods:
- A comprehensive literature search was performed across major electronic databases (MEDLINE, PubMed, LILACS, SciELO, Cochrane Library).
- Keywords included "gastroesophageal reflux," "gastroesophageal reflux disease," "proton-pump inhibitors," and "prokinetics" for pediatric age groups up to May 2013.
Main Results:
- Abdominal ultrasonography is not recommended for diagnosing gastroesophageal reflux (GER).
- Concurrent treatment of GERD and CMPA may lead to unnecessary medication or dietary interventions.
- Evidence supporting routine prokinetic use or acid suppression in infants for nonspecific GERD symptoms is insufficient.
- Conservative treatments offer benefits with low cost and minimal side effects.
Conclusions:
- Limited randomized controlled trials exist for pediatric GERD management, and no diagnostic test is considered a gold standard.
- Current practices show potential overdiagnosis and overtreatment of GERD in children, necessitating a reevaluation of diagnostic and therapeutic approaches.
Objective:
there are many questions and little evidence regarding the diagnosis and treatment of gastroesophageal reflux disease (GERD) in children. The association between GERD and cow's milk protein allergy (CMPA), overuse of abdominal ultrasonography for the diagnosis of GERD, and excessive pharmacological treatment, especially proton-pump inhibitors (PPIs) are some aspects that need clarification. This review aimed to establish the current scientific evidence for the diagnosis and treatment of GERD in children.
Data Source:
a search was conducted in the MEDLINE, PubMed, LILACS, SciELO, and Cochrane Library electronic databases, using the following keywords: gastroesophageal reflux; gastroesophageal reflux disease; proton-pump inhibitors; and prokinetics; in different age groups of the pediatric age range; up to May of 2013.
Data Synthesis:
abdominal ultrasonography should not be recommended to investigate gastroesophageal reflux (GER). Simultaneous treatment of GERD and CMPA often results in unnecessary use of medication or elimination diet. There is insufficient evidence for the prescription of prokinetics to all patients with GER/GERD. There is little evidence to support acid suppression in the first year of life, to treat nonspecific symptoms suggestive of GERD. Conservative treatment has many benefits and with low cost and no side-effects.
Conclusions:
there have been few randomized controlled trials that assessed the management of GERD in children and no examination can be considered the gold standard for GERD diagnosis. For these reasons, there are exaggerations in the diagnosis and treatment of this disease, which need to be corrected.
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