Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Diagnosis and Management of Gastroesophageal Reflux Disease in Infants and Children: from Guidelines to Clinical Practice

  • Received : 2018.12.16
  • Accepted : 2019.01.09
  • Published : 2019.03.15
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Abstract

The diagnosis and management of gastro-esophageal reflux (GER) and GER disease (GERD) in infants and children remains a challenge. Published guidelines and position papers, along with Embase, MEDLINE, and the Cochrane Database were reviewed and summarized with the intent to propose a practical approach and management of GER and GERD for healthcare providers and to standardize and improve the quality of care for infants and children. For this purpose, 2 algorithms were developed, 1 for infants <12 months of age and the other for older children. None of the signs and symptoms of GER and GERD are specific and there is no gold standard diagnostic test or tool. Nutritional management is recommended as a first-line approach in infants, while in children, a therapeutic trial with antacid medication is advised for early management. The practical recommendations from this review are intended to optimize the management of GER in infants and older children and reduce the number of investigations and inappropriate use of medication.

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References

  1. Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009;49:498-547. https://doi.org/10.1097/01.mpg.0000361306.15727.54
  2. Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2018;66:516-54. https://doi.org/10.1097/MPG.0000000000001889
  3. Gupta SK, Hassall E, Chiu YL, Amer F, Heyman MB. Presenting symptoms of nonerosive and erosive esophagitis in pediatric patients. Dig Dis Sci 2006;51:858-63. https://doi.org/10.1007/s10620-006-9095-3
  4. Martigne L, Delaage PH, Thomas-Delecourt F, Bonnelye G, Barthelemy P, Gottrand F. Prevalence and management of gastroesophageal reflux disease in children and adolescents: a nationwide cross-sectional observational study. Eur J Pediatr 2012;171:1767-73. https://doi.org/10.1007/s00431-012-1807-4
  5. Rasquin A, Di Lorenzo C, Forbes D, Guiraldes E, Hyams JS, Staiano A, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 2006;130:1527-37. https://doi.org/10.1053/j.gastro.2005.08.063
  6. Hyman PE, Milla PJ, Benninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 2006;130:1519-26. https://doi.org/10.1053/j.gastro.2005.11.065
  7. Dalla Vecchia LK, Grosfeld JL, West KW, Rescorla FJ, Scherer LR 3rd, Engum SA. Reoperation after Nissen fundoplication in children with gastroesophageal reflux: experience with 130 patients. Ann Surg 1997;226:315-21. https://doi.org/10.1097/00000658-199709000-00011
  8. Schneider A, Gottrand F, Sfeir R, Duhamel A, Bonnevalle M, Guimber D, et al. Postoperative lower esophageal dilation in children following the performance of Nissen fundoplication. Eur J Pediatr Surg 2012;22:399-403. https://doi.org/10.1055/s-0032-1315807
  9. Westra SJ, Wolf BH, Staalman CR. Ultrasound diagnosis of gastroesophageal reflux and hiatal hernia in infants and young children. J Clin Ultrasound 1990;18:477-85. https://doi.org/10.1002/jcu.1870180605
  10. Jang HS, Lee JS, Lim GY, Choi BG, Choi GH, Park SH. Correlation of color Doppler sonographic findings with pH measurements in gastroesophageal reflux in children. J Clin Ultrasound 2001;29:212-7. https://doi.org/10.1002/jcu.1022
  11. Patra S, Singh V, Chandra J, Kumar P, Tripathi M. Diagnostic modalities for gastro-esophageal reflux in infantile wheezers. J Trop Pediatr 2011;57:99-103. https://doi.org/10.1093/tropej/fmq056
  12. Ravelli AM, Panarotto MB, Verdoni L, Consolati V, Bolognini S. Pulmonary aspiration shown by scintigraphy in gastroesophageal reflux-related respiratory disease. Chest 2006;130:1520-6. https://doi.org/10.1378/chest.130.5.1520
  13. Ravelli AM, Villanacci V, Ruzzenenti N, Grigolato P, Tobanelli P, Klersy C, et al. Dilated intercellular spaces: a major morphological feature of esophagitis. J Pediatr Gastroenterol Nutr 2006;42:510-5. https://doi.org/10.1097/01.mpg.0000215312.78664.b9
  14. Cucchiara S, Minella R, D'Armiento F, Franco M, Lervolino C, Campanozzi A, et al. Histologic grading of reflux oesophagitis and its relationship with intra-oesophageal and intragastric pH variables. Eur J Gastroenterol Hepatol 1993;5:621-6. https://doi.org/10.1097/00042737-199308000-00012
  15. Arasu TS, Wyllie R, Fitzgerald JF, Franken EA, Siddiqui AR, Lehman GA, et al. Gastroesophageal reflux in infants and children comparative accuracy of diagnostic methods. J Pediatr 1980;96:798-803. https://doi.org/10.1016/S0022-3476(80)80545-2
  16. Vandenplas Y, Franckx-Goossens A, Pipeleers-Marichal M, Derde MP, Sacre-Smits L. Area under pH 4: advantages of a new parameter in the interpretation of esophageal pH monitoring data in infants. J Pediatr Gastroenterol Nutr 1989;9:34-9. https://doi.org/10.1097/00005176-198909010-00007
  17. Farhath S, He Z, Saslow J, Soundar S, Amendolia B, Bhat V, et al. Detection of pepsin in mouth swab: correlation with clinical gastroesophageal reflux in preterm infants. J Matern Fetal Neonatal Med 2013;26:819-24. https://doi.org/10.3109/14767058.2013.764408
  18. Rosen R, Johnston N, Hart K, Khatwa U, Nurko S. The presence of pepsin in the lung and its relationship to pathologic gastro-esophageal reflux. Neurogastroenterol Motil 2012;24:129-33, e84-5. https://doi.org/10.1111/j.1365-2982.2011.01826.x
  19. Farrell S, McMaster C, Gibson D, Shields MD, McCallion WA. Pepsin in bronchoalveolar lavage fluid: a specific and sensitive method of diagnosing gastro-oesophageal reflux-related pulmonary aspiration. J Pediatr Surg 2006;41:289-93. https://doi.org/10.1016/j.jpedsurg.2005.11.002
  20. Krishnan U, Mitchell JD, Messina I, Day AS, Bohane TD. Assay of tracheal pepsin as a marker of reflux aspiration. J Pediatr Gastroenterol Nutr 2002;35:303-8. https://doi.org/10.1097/00005176-200209000-00012
  21. Dy F, Amirault J, Mitchell PD, Rosen R. Salivary pepsin lacks sensitivity as a diagnostic tool to evaluate extraesophageal reflux disease. J Pediatr 2016;177:53-8. https://doi.org/10.1016/j.jpeds.2016.06.033
  22. Fortunato JE, D'Agostino RB Jr, Lively MO. Pepsin in saliva as a biomarker for oropharyngeal reflux compared with 24-hour esophageal impedance/pH monitoring in pediatric patients. Neurogastroenterol Motil 2017;29:e12936. https://doi.org/10.1111/nmo.12936
  23. O'Reilly RC, He Z, Bloedon E, Papsin B, Lundy L, Bolling L, et al. The role of extraesophageal reflux in otitis media in infants and children. Laryngoscope 2008;118 Suppl 116:1-9.
  24. Kelly EA, Parakininkas DE, Werlin SL, Southern JF, Johnston N, Kerschner JE. Prevalence of pediatric aspiration-associated extraesophageal reflux disease. JAMA Otolaryngol Head Neck Surg 2013;139:996-1001. https://doi.org/10.1001/jamaoto.2013.4448
  25. Rosen R, Fritz J, Nurko A, Simon D, Nurko S. Lipid-laden macrophage index is not an indicator of gastroesophageal reflux-related respiratory disease in children. Pediatrics 2008;121:e879-84. https://doi.org/10.1542/peds.2007-0723
  26. Tucker E, Knowles K, Wright J, Fox MR. Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high-resolution manometry studies. Aliment Pharmacol Ther 2013;37:263-74. https://doi.org/10.1111/apt.12148
  27. Kessing BF, Bredenoord AJ, Smout AJ. Objective manometric criteria for the rumination syndrome. Am J Gastroenterol 2014;109:52-9. https://doi.org/10.1038/ajg.2013.428
  28. van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA. Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics 2011;127:925-35. https://doi.org/10.1542/peds.2010-2719
  29. Haddad I, Kierkus J, Tron E, Ulmer A, Hu P, Sloan S, et al. Efficacy and safety of rabeprazole in children (1-11 years) with gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 2013;57:798-807. https://doi.org/10.1097/MPG.0b013e3182a4e718
  30. Fiedorek S, Tolia V, Gold BD, Huang B, Stolle J, Lee C, et al. Efficacy and safety of lansoprazole in adolescents with symptomatic erosive and non-erosive gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 2005;40:319-27. https://doi.org/10.1097/01.MPG.0000155369.54464.41
  31. Baker R, Tsou VM, Tung J, Baker SS, Li H, Wang W, et al. Clinical results from a randomized, double-blind, dose-ranging study of pantoprazole in children aged 1 through 5 years with symptomatic histologic or erosive esophagitis. Clin Pediatr (Phila) 2010;49:852-65. https://doi.org/10.1177/0009922810369253
  32. Tolia V, Ferry G, Gunasekaran T, Huang B, Keith R, Book L. Efficacy of lansoprazole in the treatment of gastroesophageal reflux disease in children. J Pediatr Gastroenterol Nutr 2002;35 Suppl 4:S308-18. https://doi.org/10.1097/00005176-200211004-00003
  33. Croffie JM, Fitzgerald JF, Molleston JP, Gupta SK, Corkins MR, Pfefferkorn MD, et al. Accuracy and tolerability of the Bravo catheter-free pH capsule in patients between the ages of 4 and 18 years. J Pediatr Gastroenterol Nutr 2007;45:559-63. https://doi.org/10.1097/MPG.0b013e3180dc9349
  34. Rao NM, Campbell DI, Rao P. Two years' experience of using the Bravo wireless oesophageal pH monitoring system at a single UK tertiary centre. Acta Paediatr 2017;106:312-5. https://doi.org/10.1111/apa.13667
  35. Cabrera J, Davis M, Horn D, Pfefferkorn M, Croffie JM. Esophageal pH monitoring with the BRAVO capsule: experience in a single tertiary medical center. J Pediatr Gastroenterol Nutr 2011.53:404-8. https://doi.org/10.1097/mpg.0b013e3182203caa
  36. Moon RY; Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics 2011;128:1030-9. https://doi.org/10.1542/peds.2011-2284
  37. Salvatore S, Savino F, Singendonk M, Tabbers M, Benninga MA, Staiano A, et al. Thickened infant formula: what to know. Nutrition 2018;49:51-6. https://doi.org/10.1016/j.nut.2017.10.010
  38. Koebnick C, Getahun D, Smith N, Porter AH, Der-Sarkissian JK, Jacobsen SJ. Extreme childhood obesity is associated with increased risk for gastroesophageal reflux disease in a large population-based study. Int J Pediatr Obes 2011;6:e257-63. https://doi.org/10.3109/17477166.2010.491118
  39. Pashankar DS, Corbin Z, Shah SK, Caprio S. Increased prevalence of gastroesophageal reflux symptoms in obese children evaluated in an academic medical center. J Clin Gastroenterol 2009;43:410-3. https://doi.org/10.1097/MCG.0b013e3181705ce9
  40. Ummarino D, Miele E, Martinelli M, Scarpato E, Crocetto F, Sciorio E, et al. Effect of magnesium alginate plus simethicone on gastroesophageal reflux in infants. J Pediatr Gastroenterol Nutr 2015;60:230-5. https://doi.org/10.1097/MPG.0000000000000521
  41. Miller S. Comparison of the efficacy and safety of a new aluminium-free paediatric alginate preparation and placebo in infants with recurrent gastro-oesophageal reflux. Curr Med Res Opin 1999;15:160-8. https://doi.org/10.1185/03007999909114087
  42. Salvatore S, Ripepi A, Huysentruyt K, van de Maele K, Nosetti L, Agosti M, et al. The effect of alginate in gastroesophageal reflux in infants. Paediatr Drugs 2018;20:575-83. https://doi.org/10.1007/s40272-018-0314-0
  43. Davies I, Burman-Roy S, Murphy MS; Guideline Development Group. Gastro-oesophageal reflux disease in children: NICE guidance. BMJ 2015;350:g7703. https://doi.org/10.1136/bmj.g7703
  44. Orenstein SR, Hassall E, Furmaga-Jablonska W, Atkinson S, Raanan M. Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. J Pediatr 2009;154:514-520.e4. https://doi.org/10.1016/j.jpeds.2008.09.054
  45. Yadlapati R, Kahrilas PJ. The “dangers” of chronic proton pump inhibitor use. J Allergy Clin Immunol 2018;141:79-81. https://doi.org/10.1016/j.jaci.2017.06.017
  46. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013;108:308-28. https://doi.org/10.1038/ajg.2012.444
  47. Rosen R, Amirault J, Liu H, Mitchell P, Hu L, Khatwa U, et al. Changes in gastric and lung microflora with acid suppression: acid suppression and bacterial growth. JAMA Pediatr 2014;168:932-7. https://doi.org/10.1001/jamapediatrics.2014.696
  48. Trikha A, Baillargeon JG, Kuo YF, Tan A, Pierson K, Sharma G, et al. Development of food allergies in patients with gastroesophageal reflux disease treated with gastric acid suppressive medications. Pediatr Allergy Immunol 2013;24:582-8. https://doi.org/10.1111/pai.12103
  49. Khoshoo V, Dhume P. Clinical response to 2 dosing regimens of lansoprazole in infants with gastroesophageal reflux. J Pediatr Gastroenterol Nutr 2008;46:352-4. https://doi.org/10.1097/MPG.0b013e31815667d7
  50. Omari TI, Benninga MA, Sansom L, Butler RN, Dent J, Davidson GP. Effect of baclofen on esophagogastric motility and gastroesophageal reflux in children with gastroesophageal reflux disease: a randomized controlled trial. J Pediatr 2006;149:468-74. https://doi.org/10.1016/j.jpeds.2006.05.029
  51. Li S, Shi S, Chen F, Lin J. The effects of baclofen for the treatment of gastroesophageal reflux disease: a meta-analysis of randomized controlled trials. Gastroenterol Res Pract 2014;2014:307805.
  52. De Loore I, Van Ravensteyn H, Ameryckx L. Domperidone drops in the symptomatic treatment of chronic paediatric vomiting and regurgitation. A comparison with metoclopramide. Postgrad Med J 1979;55 Suppl 1:40-2.
  53. Carroccio A, Iacono G, Montalto G, Cavataio F, Soresi M, Notarbartolo A. Domperidone plus magnesium hydroxide and aluminum hydroxide: a valid therapy in children with gastroesophageal reflux. A double-blind randomized study versus placebo. Scand J Gastroenterol 1994;29:300-4. https://doi.org/10.3109/00365529409094839
  54. Lau Moon Lin M, Robinson PD, Flank J, Sung L, Dupuis LL. The Safety of metoclopramide in children: a systematic review and meta-analysis. Drug Saf 2016;39:675-87. https://doi.org/10.1007/s40264-016-0418-9
  55. Morris AD, Chen J, Lau E, Poh J. Domperidone-associated QT interval prolongation in non-oncologic pediatric patients: a review of the literature. Can J Hosp Pharm 2016;69:224-30.
  56. Levi P, Marmo F, Saluzzo C, Dell'Olio D, Ansaldi N, Giuliani L, et al. Bethanechol versus antiacids in the treatment of gastroesophageal reflux. Helv Paediatr Acta 1985;40:349-59.
  57. Euler AR. Use of bethanechol for the treatment of gastroesophageal reflux. J Pediatr 1980;96:321-4. https://doi.org/10.1016/S0022-3476(80)80839-0
  58. Rohof WO, Bennink RJ, de Ruigh AA, Hirsch DP, Zwinderman AH, Boeckxstaens GE. Effect of azithromycin on acid reflux, hiatus hernia and proximal acid pocket in the postprandial period. Gut 2012;61:1670-7. https://doi.org/10.1136/gutjnl-2011-300926
  59. Rothenberg SS. Two decades of experience with laparoscopic nissen fundoplication in infants and children: a critical evaluation of indications, technique, and results. J Laparoendosc Adv Surg Tech A 2013;23:791-4. https://doi.org/10.1089/lap.2013.0299
  60. Hambraeus M, Arnbjornsson E, Anderberg M. A literature review of the outcomes after robot-assisted laparoscopic and conventional laparoscopic Nissen fundoplication for gastro-esophageal reflux disease in children. Int J Med Robot 2013;9:428-32. https://doi.org/10.1002/rcs.1517

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