Pocket guidelines: pediatric GERD management

  • Barfield E & al.
  • JAMA Pediatr
  • 18 Mar 2019

  • International Clinical Digest
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Takeaway

  • The 2018 pediatric GERD guidelines stand out for taking a “question-based” approach, offering diagnostic and therapeutic algorithms for infants and children and suggesting a trial of acid suppression in older children.

Why this matters

  • This JAMA Pediatrics guidelines synopsis offers a quick-reference pocket version of the major recommendations from the guidelines.

Key recommendations

  • Avoid barium contrast studies, esophagogastroduodenoscopy, manometry to diagnose. 
  • Wean after 4-8 weeks of optimal drug management, regardless of response.
  • Infants: try feeding modifications (volume, frequency, hydrolyzed protein formula).
  • No positional therapy in sleeping infants. 
  • No gastroesophageal reflux disease (GERD) meds for crying, regurgitation in otherwise healthy children.
  • Avoid GERD meds with extraesophageal symptoms.
  • Proton pump inhibitors, histamine receptor antagonists: both carry risks, adverse effects to consider.
  • Formula thickeners: continued breastfeeding recommended; effects of thickening on nonregurgitation are unclear, and arsenic in rice cereals is a concern; severe bowel complications are a concern with commercial thickeners (e.g., xanthan gum).

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