GERD/Acid Reflux

MDNG Pediatrics, December 2010, Volume 8, Issue 4

//The Educated PatientFact Sheet: Pediatric GERD

More than 50% of children age three months or younger have at least one episode of regurgitation a day, and 10% of infants with gastroesophageal reflux (GER) develop significant complications. This resource from the American Academy of Otolarygology—Head and Neck Surgery helps educate parents by explaining what symptoms are found in children with gastroesophageal reflux disease (GERD); identifying the different methods used to diagnose GERD, including pH probe, barium swallow or upper GI series, and technetium gastric emptying study; and discussing treatment options for infants and older children.

Infant Acid Reflux

Although infant acid reflux occurs most often after a feeding, “it can happen anytime your baby coughs, cries or strains,” and “typically resolves on its own when your baby is around 12 to 18 months old,” according to this MayoClinic.com resource. Parents of infants with acid reflux can go here to learn about the symptoms, causes, and complications of the condition, how to prepare for physician visit, the tests used to diagnose it, and what course of treatment might be recommended. Also included are tips for managing infant acid reflux on an everyday basis.

Pediatric GERD

At this site from the Children’s Digestive Health and Nutrition Foundation, information on managing GERD is provided for three age groups: infants, children ages 3-11, and teenagers. Among the resource featured here are: a video and podcast on “Infant Reflux and GERD: Distinctions and Management,” an infant reflux checklist, a coloring book featuring a character named Gerdie that teaches kids about the functions of the gastrointestinal system and offers tips on avoiding foods that can cause stomach problems, and a link to “Coping When Your Baby Has Reflux or GERD,” a helpful guide for parents. Also included are a video and podcast on “Adolescent Reflux and GERD: Distinctions and Management,” a listing of lifestyle changes that can help kids ages 2-12, and information on information on medical therapies, and psychosocial issues of GERD.

//Medical Websites

Pediatric Gastroesophageal Reflux Clinical Practice Guideline Summary

Designed to assist care providers in the evaluation and management of gastroesophageal reflux and GERD in pediatric patients, this guideline summary features “recommendations based on the best available evidence from the literature combined with expert opinion.” Included in the guidelines—which were written by experts from the North American and European Societies for Pediatric Gastroenterology, Hepatology and Nutrition—are the clinical manifestations of GERD in children, warning signals in infants and children, diagnostic approaches, treatment options, information on the evaluation and management of infants and children with suspected GERD, and a listing of which patient groups are at high risk for GERD.

A Global, Evidence Based Consensus on the Definition of Gastroesophageal Reflux Disease in the Pediatric Population-Summary

The variety of definitions of GERD and “inconsistent nomenclature contributes to wide variations in treatment, as well as confusion in interpreting clinical trial literature and employing the available diagnostic tests,” according to this site, which seeks to provide pediatric health care providers, general pediatricians and subspecialists with a uniform definition of GERD that can be employed in infants, children, and adolescents. Visit this site for detailed information on definitions related in GERD in infants, symptoms of the condition, conditions that predispose pediatric patients to severe and chronic GERD, symptoms of esophageal injury, and extraesophageal syndromes.

//Online CMEOverview of Pediatric Gastroesophageal Reflux Disease (GERD)Credits: 1.00

Fee: None

Expires: January 29, 2011

Multimedia: Audio/Video

In this Grand Rounds webcast, Karina Irizarry, MD, a pediatric gastroenterologist based in Tampa, FL, explains how to recognize clinical manifestations of GERD in children and implement appropriate pharmacological therapy for this patient population. Don’t wait too long before taking this course; CME credit expires in January.

Overcoming Challenges in Pediatric GERDCredits: 0.25

Fee: None

Expires: August 16, 2011

Multimedia: Audio/Slides

Listen as David A. Gremse, MD, of the University of Nevada School of Medicine, discusses identification and management of refractory GERD and its complications in pediatric patients. The course also covers risk factors for severe and persistent GERD in pediatric patients and when to refer to specialists.

EQIPP: Differentiate and Manage — GER and GERDCredits: 30.00

Fee: $199 for AAP members; $229 for non-members

Expires: January 19, 2013

Multimedia: None

The goal of this course is to help physicians “create a plan for improvement to address gaps you identify in key clinical activities in GER and GERD.” Completion of the entire course can result in 10 credits for the clinical content portion, and an additional 20 credits for performance improvement for those who qualify. After reviewing educational material on quality improvement and GER and GERD management and analyzing data to identify gaps in care, participants will create an improvement plan that will identify a specific aim, establish a target goal, generate ideas for change, and consider potential barriers. They will then implement the changes, and create additional improvement plans and repeat the change-improvement cycle until the goal is reached of “providing the best possible GER and GERD care to patients.” Visit the link below for information on registration and the course itself.

//Clinical TrialsThe Role of Anti-Reflux Surgery for Gastroesophageal Reflux Disease in Premature Infants with Bronchopulmonary DysplasiaStudy Type: Interventional

Age/Gender Requirements: 24 weeks-12 months (male/female)

Sponsor: The University of Texas Health Science Center, Houston

Purpose: As knowledge of GERD improves, new therapies are being evaluated. This six-month study aims to evaluate the efficacy of fundoplication—an anti-reflux surgery—in premature infants with GERD and bronchopulmonary dysplasia.

A Study of the Safety and Effectiveness of Rabeprazole for the Treatment of Gastroesophageal Reflux Disease in Pediatric PatientsStudy Type: Interventional

Age/Gender Requirements: 1-11 years (male/female)

Sponsor: Johnson & Johnson Pharmaceutical Research & Development

Purpose: This multicenter, double-blind, parallel-group study is being conducted to assess the effectiveness and safety of oral rabeprazole in the treatment of acid-related disorders in pediatric patients, focusing specifically on the manifestation of GERD (symptomatic and erosive types).

//eAbstractsLong-Term Follow-up of Patients with Esophageal Replacement by Reversed Gastric TubeJournal: European Journal of Pediatric Surgery (November 5, 2010)

Authors: Gupta L, Bhatnagar V, Gupta A, Kumar R.

Purpose: A review of 16 patients who had undergone reversed gastric tube esophagoplasty between March 1990 and March 2009 was conducted to evaluate long-term outcomes in children who underwent esophageal replacement by reversed gastric tube, and to assess certain aspects of the physiological function and behavior of the reversed gastric tube.

Results: Of the 16 children, researchers found that 12 were between the 3rd and 97th percentiles for weight and 10 were between the 3rd and 97th percentiles for height for their respective age group. Most (14) were eating and swallowing normally, and none of the patients had respiratory problems. “Almost all children remained asymptomatic and led a normal life” they concluded, adding that “the function of the neoesophagus was good and growth and nutrition in the majority of patients was satisfactory.”

Temporal Relationship between Gastroesophageal Reflux and Rate of Gastric Emptying in ChildrenJournal: Nuclear Medicine Communications (December 2010)

Authors: Sager S, Halac M, Selcuk N, et al.

Purpose: To assess the temporal distribution of the reflux episodes in pediatric patients, and to evaluate whether the gastric emptying rate changed with the gastroesophageal reflux time or amount.

Results: Of the 211 patients observed, 104 (49.3%) were found to have gastric reflux, and the number of reflux episodes was higher in the first and second 10 minutes in a one-hour interval. Analyses showed that the number of reflux episodes was not related with the gastric emptying rate. “However, reflux could be observed in a higher frequency before gastric emptying, which also suggested that a 30-minute period may be sufficient when reflux is shown early. In negative cases, a 60-min acquisition time is recommended for the diagnosis of gastroesophageal reflux.”

Pharma FocusProtonix (Pantoprazole)

//Clinical TrialsIntravenous Pantoprazole for Gastroesophageal Reflux Disease in Neonates and InfantsStudy Type: Interventional

Age/Gender Requirements: 28 weeks-11 months (male/female)

Sponsor: University of Louisville

Purpose: With this pharmacokinetic study, investigators aim to “determine how the body uses and eliminates pantoprazole,” a drug approved for use of acid-related and stomach disorders in adults, but not children. The results will be used to determine the best dose of the drug to use in different pediatric age groups.

//eAbstractsEfficacy and Safety of Pantoprazole Delayed-release Granules for Oral Suspension in a Placebo-controlled Treatment-withdrawal Study in Infants 1-11 Months old with Symptomatic GERDJournal: Journal of Pediatric Gastroenterology and Nutrition (October 2010)

Authors: Winter H, Kum-Nji P, Mahomedy SH, et al.

Purpose: To assess the efficacy of pantoprazole in infants with gastroesophageal reflux disease; after two weeks of conservative treatment, subjects received open-label pantoprazole 1.2 mg x kg(-1) x day(-1) for 4 weeks, followed by a 4-week withdrawal phase.

Results: Pantoprazole was shown to significantly improve GERD symptom scores and was well tolerated in infants. However, researchers found that during the double-blind treatment phase, “there were no significant differences noted between pantoprazole and placebo in withdrawal rates due to lack of efficacy.”