CE/CME

Pediatric GERD

Clinician Reviews. 2013 May;23(5):40-47

References

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PROGNOSIS AND FOLLOW-UP
The large majority of infants respond well to conservative nonpharmacologic treatment and outgrow their reflux symptoms by age 1 year, with maturation of muscle control and lower esophageal sphincter function.⁷ Further testing and intervention is generally not required in healthy infants, and parents should be reassured by this information.^6,7 If regurgitation does not resolve by age 12 to 18 months, or if red-flag symptoms develop, referral to a pediatric gastroenterologist is recommended.⁶

For older children and adolescents with GERD, lifestyle changes should be implemented first, followed by short-term pharmacologic intervention, as recommended by appropriate guidelines.

Children with other illnesses or complications, such as neurologic impairment, premature birth, or a strong family history of severe GERD, have a poorer prognosis and may require more aggressive diagnostic evaluation and management.⁷ Complications such as esophageal stricture and Barrett’s esophagus, which poses an increased risk for adenocarcinoma, require referral to a specialist for further evaluation.¹⁰

CONCLUSION
GERD is no longer a condition found only in adults. Since primary care practitioners are increasingly likely to see GERD in their pediatric patients, it is important for these clinicians to become familiar with the contributing factors, definitive signs and symptoms, diagnosis, and treatment of GERD. Children at high risk for GERD should be followed closely and introduced to appropriate lifestyle modifications to avoid the troublesome symptoms of GERD and its complications, whenever possible. In the differential diagnosis, respiratory illnesses and other extra-esophageal diseases, as well as eosinophilic esophagitis in allergic patients, should be considered.

Practitioners should consult the 2009 NASPGHAN/ESPGHAN clinical practice guidelines for further details regarding the evaluation, diagnosis, preferred treatment, management of pediatric GERD, and indications for specialist referral. Research is ongoing in many areas, including the suitability of PPI use in pediatrics. More research is needed to clarify the theorized link between GERD and asthma.