GERD Management Guidelines New

Diagnosis

1. Avoid barium contrast studies, esophago-gastro-duodenoscopy, scintigraphy, and manometry to diagnose GERD in both infants and children
2. The diagnosis is mainly by a careful history, physical examination, ruling out other conditions in presence of ‘red flag’ signs; pH-metry and pH impedance studies may be required in few cases to correlate symptoms with episodes of acid reflux events.
3. A 4- to 8-week trial of PPIs may be considered as a diagnostic test for typical GERD symptoms in children, but not in infants or in children with extra-gastrointestinal symptoms

Treatment

Infants

1. Modify feeding volumes and frequency to avoid overfeeding and use thickened feeds for treating visible regurgitation/vomiting.
2. Continue breastfeeding; consider elimination of animal milk protein in mothers in case of non-improvement
3. A 2- to 4-week trial of a formula with extensively hydrolyzed protein (or amino-based formula) in formula-fed infants suspected of having GERD after optimal nonpharmacological treatment described above has failed.
4. Avoid positional therapy (ie, head elevation, lateral and prone positioning) in sleeping infants.
5. Consider 4-8 week trial of acid suppression with H2 antagonists or PPI, then wean if symptoms improved

Children

1. Avoid H2RA or PPIs in children with extra-esophageal symptoms (eg, respiratory) except in presence of typical GERD symptoms
2. Consider head elevation or left lateral position to treat GERD symptoms.
3. Consider 4-8 week trial of acid suppression with H2 antagonists or PPI, then wean if symptoms improved

Source: 2018 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). JAMA Pediatr. 2019;173(5):485-486. doi:10.1001/jamapediatrics.2019.0170

To read full Guidelines:

https://www.naspghan.org/files/Pediatric_Gastroesophageal_Reflux_Clinical.33.pdf

Compiled by

PIYUSH GUPTA MD, FIAP, FNNF, FAMS
Professor of Pediatrics

University College of Medical Sciences, Delhi

9625900641

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