Gastroesophageal reflux: Management guidance for the pediatrician

Jenifer R. Lightdale, David A. Gremse, Leo A. Heitlinger, Michael Cabana, Mark A. Gilger, Roberto Gugig, Ivor D. Hill

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

Recent comprehensive guidelines developed by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition define the common entities of gastroesophageal reflux (GER) as the physiologic passage of gastric contents into the esophagus and gastroesophageal reflux disease (GERD) as reflux associated with troublesome symptoms or complications. The ability to distinguish between GER and GERD is increasingly important to implement best practices in the management of acid reflux in patients across all pediatric age groups, as children with GERD may benefit from further evaluation and treatment, whereas conservative recommendations are the only indicated therapy in those with uncomplicated physiologic reflux. This clinical report endorses the rigorously developed, well-referenced North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines and likewise emphasizes important concepts for the general pediatrician. A key issue is distinguishing between clinical manifestations of GER and GERD in term infants, children, and adolescents to identify patients who can be managed with conservative treatment by the pediatrician and to refer patients who require consultation with the gastroenterologist. Accordingly, the evidence basis presented by the guidelines for diagnostic approaches as well as treatments is discussed. Lifestyle changes are emphasized as first-line therapy in both GER and GERD, whereas medications are explicitly indicated only for patients with GERD. Surgical therapies are reserved for children with intractable symptoms or who are at risk for life-threatening complications of GERD. Recent black box warnings from the US Food and Drug Administration are discussed, and caution is underlined when using promoters of gastric emptying and motility. Finally, attention is paid to increasing evidence of inappropriate prescriptions for proton pump inhibitors in the pediatric population.

Original languageEnglish (US)
Pages (from-to)e1684-e1695
JournalPediatrics
Volume131
Issue number5
DOIs
StatePublished - May 1 2013
Externally publishedYes

Fingerprint

Gastroesophageal Reflux
Gastroenterology
Pediatrics
Pediatricians
Drug Labeling
Inappropriate Prescribing
Guidelines
Nutrition Policy
Gastrointestinal Contents
Aptitude
Proton Pump Inhibitors
Gastric Emptying
Practice Management
United States Food and Drug Administration
Therapeutics
Practice Guidelines
Esophagus
Life Style
Referral and Consultation
Age Groups

Keywords

  • Barrett esophagus
  • Diagnostic imaging
  • Extraesophageal symptoms
  • Gastroesophageal reflux
  • Gastroesophageal reflux disease
  • Gastrointestinal endoscopy
  • Global consensus
  • Guidelines
  • Impedance monitoring
  • Lifestyle changes
  • Pediatrics
  • Proton pump inhibitors
  • Reflux-related disease
  • Regurgitation
  • Review
  • Rumination
  • Vomiting

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Lightdale, J. R., Gremse, D. A., Heitlinger, L. A., Cabana, M., Gilger, M. A., Gugig, R., & Hill, I. D. (2013). Gastroesophageal reflux: Management guidance for the pediatrician. Pediatrics, 131(5), e1684-e1695. https://doi.org/10.1542/peds.2013-0421

Gastroesophageal reflux : Management guidance for the pediatrician. / Lightdale, Jenifer R.; Gremse, David A.; Heitlinger, Leo A.; Cabana, Michael; Gilger, Mark A.; Gugig, Roberto; Hill, Ivor D.

In: Pediatrics, Vol. 131, No. 5, 01.05.2013, p. e1684-e1695.

Research output: Contribution to journalArticle

Lightdale, JR, Gremse, DA, Heitlinger, LA, Cabana, M, Gilger, MA, Gugig, R & Hill, ID 2013, 'Gastroesophageal reflux: Management guidance for the pediatrician', Pediatrics, vol. 131, no. 5, pp. e1684-e1695. https://doi.org/10.1542/peds.2013-0421
Lightdale JR, Gremse DA, Heitlinger LA, Cabana M, Gilger MA, Gugig R et al. Gastroesophageal reflux: Management guidance for the pediatrician. Pediatrics. 2013 May 1;131(5):e1684-e1695. https://doi.org/10.1542/peds.2013-0421
Lightdale, Jenifer R. ; Gremse, David A. ; Heitlinger, Leo A. ; Cabana, Michael ; Gilger, Mark A. ; Gugig, Roberto ; Hill, Ivor D. / Gastroesophageal reflux : Management guidance for the pediatrician. In: Pediatrics. 2013 ; Vol. 131, No. 5. pp. e1684-e1695.
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