The Royal Australasian College of Physicians advises against the routine use of acid suppression therapy to treat gastro-oesophageal reflux disease (GORD) in infants. Gastro-oesophageal reflux (GOR) is a normal physiological process that usually occurs after eating. This is commonly observed in well infants with at least 40%experiencing effortless regurgitation of feeds. Although this condition may cause parental distress, it reduces in frequency over time and resolves in 90% of affected infants by 12 months of age.

It is recommended that further investigation and pharmacological therapy are not required for uncomplicated GOR in infants who are thriving. When the effects of this reflux lead to complications, the condition is known as GORD and treatment is often sought. Signs that may be associated with GORD include failure to thrive, oesophagitis, stricture, refusal to feed, recurrent pneumonia, and apnoea.

Acid suppression therapy with either a proton pump inhibitor or histamine Hreceptor antagonist is the mainstay of GORD treatment. However, there is limited evidence to support their safety and efficacy in infants. A number of double-blind placebo-controlled studies have found no difference between active and placebo groups for the reduction of feeding-related symptoms. In light of this uncertain benefit, the real risk of adverse effects must be carefully considered. Some studies suggest an association between acid-suppression therapy in infants and children and conditions such as necrotising enterocolitis, sepsis, pneumonia, and gastroenteritis.

The poor efficacy reported for these agents may be partly explained by the difficulty in diagnosing GORD in this population. Some of the symptoms of GOR and GORD are non-specific which makes it difficult to distinguish between the two conditions. Studies have also found little correlation between symptoms and the findings of endoscopy and pH testing with only 20% of infants referred for persistent regurgitation having evidence of oesophageal acid reflux. Conditions that increase the risk of GORD include cystic fibrosis, oesophageal atresia, and severe neurological disorders.

References:

  1. Chung EY, Yardley J. Are there risks associated with empiric acid suppression treatment of infants and children suspected of having gastroesophageal reflux disease? Hosp Pediatr. 2013; 3(1): 16-23.
  2. National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease in children and young people: diagnosis and management. NICE Guideline; 2015.
  3. Romano C, Chiaro A, Comito D, Loddo I, Ferrau V. Proton pump inhibitors in pediatrics: evaluation of efficacy in GERD therapyCurr Clin Pharmacol. 2011; 6(1): 41-7.
  4. Royal Australasian College of Physicians. Paediatrics and Child Health Division Top 5 Low-Value Practices and Interventions. Sydney: RACP; 2017.

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