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Gastroesophageal reflux in children: an updated review. | LitMetric

Gastroesophageal reflux in children: an updated review.

Drugs Context

Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.

Published: June 2019

AI Article Synopsis

  • - Gastroesophageal reflux is a common issue in children that usually involves regurgitation and is often harmless, typically resolving on its own as infants grow.
  • - Diagnosis usually requires just a clinical history and physical exam, but if unclear, advanced tests like pH monitoring may be used to confirm gastroesophageal reflux disease (GERD).
  • - Most instances don't require treatment beyond reassurance; however, if symptoms are troublesome, strategies like thickened feedings, adjusting feeding positions, and sometimes medication can be helpful.

Article Abstract

Background: Gastroesophageal reflux is a common disorder in pediatrics. Clinicians should be familiar with the proper evaluation and management of this condition.

Objective: To provide an update on the current understanding, evaluation, and management of gastroesophageal reflux in children.

Methods: A PubMed search was performed with Clinical Queries using the key term 'gastroesophageal reflux'. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature and the pediatric age group.

Results: Regurgitation is the most frequent symptom of gastroesophageal reflux and is present in nearly all cases. Gastroesophageal reflux occurs normally in infants, is often physiological, peaks at 4 months of age, and tends to resolve with time. Gastroesophageal reflux disease occurs when gastric contents reflux into the esophagus or oropharynx and produce troublesome symptom(s) and/or complication(s). A thorough clinical history and a thorough physical examination are usually adequate for diagnosis. When the diagnosis is ambiguous, diagnostic studies may be warranted. A combined esophageal pH monitoring and multichannel intraluminal esophageal electrical impedance device is the gold standard for the diagnosis of gastroesophageal reflux disease if the diagnosis is in doubt. In the majority of cases, no treatment is necessary for gastroesophageal reflux apart from reassurance of the benign nature of the condition. Treatment options for gastroesophageal reflux disease are discussed.

Conclusion: In most cases, no treatment is necessary for gastroesophageal reflux apart from reassurance because the condition is benign and self-limiting. Thickened feedings, postural therapy, and lifestyle changes should be considered if the regurgitation is frequent and problematic. Pharmacotherapy should be considered in the treatment of more severe gastroesophageal reflux disease for patients who do not respond to conservative measures. Proton pump inhibitors are favored over H-receptor antagonists because of their superior efficacy. Antireflux surgery is indicated for patients with significant gastroesophageal reflux disease who are resistant to medical therapy.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6586172PMC
http://dx.doi.org/10.7573/dic.212591DOI Listing

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