Tuesday, April 30th, 2013
New guidelines from the American Academy of Pediatrics (AAP) urge doctors to distinguish between gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) when diagnosing infants who suffer from the very common complaint of reflux. The guidelines follow a study published earlier this month in the journal Pediatrics, which concluded that high rates of GERD may be resulting in over-medicated infants.
More on the AAP’s new recommendations:
Making the appropriate diagnosis will identify patients who can be treated with lifestyle changes alone or those who require more intensive therapies, according to Jenifer Lightdale, MD, MPH, of Boston Children’s Hospital, David Gremse, MD, of the University of South Alabama Health System in Mobile, and colleagues from the AAP section on gastroenterology, hepatology, and nutrition.
Among patients with either condition, lifestyle changes — such as modifying maternal diets in breastfeeding mothers or avoiding spicy foods in older children — are recommended as a first-line therapy, while more intensive treatments are recommended for those with intractable symptoms or life-threatening GERD-related complications, they wrote online in Pediatrics.
GER is common to more than two-thirds of infants who are otherwise healthy and “is considered a normal physiologic process that occurs several times a day in healthy infants, children, and adults,” they wrote.
The condition is “generally associated with transient relaxations of the lower esophageal sphincter independent of swallowing, which permits gastric contents to enter the esophagus,” they explained.
While GER is short lived and can cause few to no symptoms in healthy adults, GERD is characterized by mucosal injury on upper endoscopy and can result in vomiting, poor weight gain, dysphagia, abdominal or substernal/retrosternal pain, and esophagitis.
Symptoms of GERD can also include cough, laryngitis, and, in infants, wheezing, as well as dental erosion, pharyngitis, sinusitis, and recurrent otitis media.
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