Posts Tagged ‘ GERD ’

Doctors Say Not All Infant Reflux Is Disease

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.

Image: Upset infant, via Shutterstock

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Is GERD Diagnosis Leading to Overmedicated Infants?

Thursday, April 4th, 2013

Doctors are increasingly making the diagnosis of “GERD,” or gastroesophageal reflux disease, in infants, and the label may be prompting parents to medicate for infant issues that pediatricians would otherwise regard as normal, such as crying and spitting up.

A new report published in the journal Pediatrics argues that the use of the disease label is leading to the growing use of medication.  “Labeling an otherwise healthy infant as having a “disease” increased parents’ interest in medicating their infant when they were told that medications are ineffective,” the article concludes. “These findings suggest that use of disease labels may promote overtreatment by causing people to believe that ineffective medications are both useful and necessary.”

Previous research has already established the growing number of medical interventions for GERD.  One 2010 study by the Food and Drug Administration found that the prescription rate for a particular class of acid blockers increased 11-fold in the years between 2002 and 2009 for babies under age 1.

The new study, which was conducted as a survey of parents in a general pediatric clinic, attributes the rise to the use of the disease label GERD.  From the survey’s abstract, “Parents who received a GERD diagnosis were interested in medicating their infant, even when they were told that the medications are likely ineffective. However, parents not given a disease label were interested in medication only when medication effectiveness was not discussed (and hence likely assumed).”

Image: Crying newborn baby, via Shutterstock

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