Guidelines
Guidelines
Clinical practice guidelines on pediatric gastroesophageal reflux by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) recommend the following [23, 24] :
-
Four to eight weeks of acid-suppression therapy is recommended to treat typical reflux symptoms. This should only occur after dietary modifications in infants are unsuccessful.
-
Avoid acid suppression in infants and children with extraesophageal symptoms (eg, cough, wheezing, asthma).
-
GERD complications should be assessed with esophagogastroduodenoscopy (EGD) with biopsies.
-
pH/impedance studies are recommended to see the role of acid reflux in esophagitis and whether acid-suppression therapy was effective.
-
Diagnosing GERD with salivary pepsin, extraesophageal biomarkers, and scintigraphy is not recommended.
-
Only use manometry if there is suspicion of an underlying motility disorder.
-
Positional therapy to treat reflux in infants is not recommend.
-
Proton pump inhibitors can be used as treatment for erosive esophagitis.
Media Gallery
-
The image is a representation of concomitant intraesophageal pH and esophageal electrical impedance measurements. The vertical solid arrow indicates commencement of a nonacid gastroesophageal reflux episode (diagonal arrow). The vertical dashed arrow indicates the onset of a normal swallow.
-
Algorithm for evaluation and "step-up" management of gastroesophageal reflux (GER).
-
Illustration of the Nissen fundoplication. Note how the stomach is wrapped around the esophagus (360-degree wrap).
of
3