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Infant gastroesophageal reflux disease management consensus
Yvan Vandenplas1, Marina Orsi2, Marc Benninga3
1Department of Pediatrics, Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium.
Insights
Infant gastroesophageal reflux disease management needs improvement. Experts recommend against acid suppression for non-acid reflux in infants, highlighting an unmet need for effective treatments.
Area of Science:
- Pediatric Gastroenterology
- Clinical Consensus
- Evidence-Based Medicine
Background:
- Infant gastroesophageal reflux is often benign, but complications can indicate gastroesophageal reflux disease (GERD).
- Current management of infant GERD faces unmet needs, particularly due to differences in reflux composition (breast milk/formula) compared to older populations.
- Existing clinical practice shows low awareness and adherence to guidelines for infant reflux management.
Purpose of the Study:
- To establish expert-driven recommendations for infant gastroesophageal reflux (disease) management.
- To address specific clinical aspects and unmet needs in pediatric reflux care.
- To provide guidance based on published literature and clinical expertise.
Main Methods:
- A Delphi consensus methodology was employed.
- 18 statements regarding infant gastroesophageal reflux (disease) were developed.
- An online, anonymized voting system facilitated consensus among expert panelists.
Main Results:
- A consensus was reached on all 18 statements by the expert panel.
- Paediatric gastroenterology specialists participated in the consensus process.
- The consensus highlighted low guideline adherence in clinical practice.
Conclusions:
- Acid suppression therapy is not indicated for non-acid reflux in infants, which is common.
- There is a significant unmet medical need for therapies targeting symptomatic infants with non-acid reflux disease.
- Improved awareness and adherence to guidelines are crucial for optimal infant reflux management.
Aim:
Infant gastroesophageal reflux is mostly benign; however, when associated with complications like failure to thrive, it may be indicative of gastroesophageal reflux disease. There are currently several unmet needs pertaining to the management of infant gastroesophageal reflux (disease). Reflux in infants is mostly composed of breast milk or formula, so this population is significantly different to older children and adults. The objective of this Delphi consensus was to establish recommendations based on published literature and the experience of clinical experts in paediatric gastroenterology in the context of infant gastroesophageal reflux (disease).
Methods:
The Delphi methodology was used to obtain a consensus on 18 statements relating to clinical aspects of infant gastroesophageal reflux (disease).
Results:
The expert panel comprising paediatric gastroenterology clinical specialists reached a consensus for all statements by means of an online, anonymised voting system.
Conclusion:
It was highlighted that there is generally low awareness of or adherence to guidelines in clinical practice and that acid suppression therapy should not be indicated for non-acid reflux, which constitutes a significant proportion of total gastroesophageal reflux episodes among infants. Furthermore, it was emphasised that there is an unmet medical need for therapy for some symptomatic infants with non-acid reflux disease.
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