Anti-regurgitation Formula Research Articles

Digestive Tolerance and Safety of an Anti-Regurgitation Formula Containing Locust Bean Gum, Prebiotics and Postbiotics: A Real-World Study.

Infant regurgitation is associated with other functional gastrointestinal disorders and signs and symptoms that have a major impact on the quality of life of infants and their families. This study evaluated the safety, tolerance, and real-world effectiveness of an anti-regurgitation formula containing locust bean gum (LBG), prebiotics, and postbiotics to alleviate digestive symptoms beyond regurgitation. This 3-month study involved infants with regurgitation requiring the prescription of an anti-regurgitation formula according to usual clinical practice. Outcomes included evaluation of the evolution of stool consistency and frequency; occurrence of colic, constipation, and diarrhea; and assessment of regurgitation severity. Infant crying, parental assessment of infant well-being, and parental satisfaction with the stool consistency were also evaluated. In total, 190 infants (average age: 1.9±1.1 months) were included. After three months, stool frequency and consistency remained within the normal physiological range, with 82.7% of infants passing one or two stools per day and 90.4% passing loose or formed stools. There was no significant increase in the number of infants with diarrhea, whereas a decrease was observed in the number of infants with constipation after 1 month (p=0.001) and with colic after both 1 and 3 months (p<0.001). Regurgitation severity and crying decreased and parental satisfaction with stool consistency, formula acceptability, infant well-being, and sleep quality increased. Monitoring of adverse events did not reveal any safety concerns. Formulas containing LBG, prebiotics, and postbiotics were well tolerated and provided an effective strategy for managing infant regurgitation and gastrointestinal discomfort.

Efficacy and safety of medical and nutritional management of gastroesophageal reflux in formula-fed infants: a narrative review.

The prescription of proton pump inhibitors has an increasing trend, despite that guidelines recommend nutritional management as first-line management. A thickened antiregurgitation formula is recommended in formula-fed infants. In this review we focus on the novel insights in management of formula-fed infants with gastroesophageal reflux disease (GERD). New data are limited. Concerning thickened antiregurgitation formula, locust bean gum has been the most studied and has limited adverse effects. However, positive results were also obtained with pectin. The effect of pro- and prebiotics on regurgitation is unclear. The overlap between cow's milk allergy and gastroesophageal reflux remains a challenge. Very limited new data were published during the last 18 months. Thickened antiregurgitation formula is the first-line approach in formula-fed infants with GERD. No specific thickening agent can be recommended because of lack of comparative trials. Proton pump inhibitors are over prescribed in infants.

Infant Formulas With Postbiotics: An Updated Systematic Review.

Infant formulas (IF) with postbiotics, defined as inanimate microorganisms and/or their components that confer a health benefit on the host, are available. We systematically updated evidence on the safety and health effects of administering iF with postbiotics (with or without other modifications) compared with standard IF. The Cochrane Library, MEDLINE, and EMBASE databases were searched to December 2021. Eleven randomized controlled trials were included. Using the Cochrane Risk of Bias Tool 2, for the primary outcomes, 5 trials had an overall high risk of bias, and 6 trials had some concerns of bias. Most data were available on IF fermented with Bifidobacterium breve C50 and Streptococcus thermophilus (BB/ST). These formulas, compared with the standard IF, were safe and well tolerated. Postbiotic formulas with additional modifications (ie, formula fermented with BB/ST & prebiotics, partly fermented formula with BB/ST and prebiotics with or without modified milk fat, partly fermented antiregurgitation formula with BB/ST and prebiotics) were generally safe and well tolerated but did not offer clear benefits replicated in other studies. Only limited data were available on formula fermented with Lactobacillus paracasei CBA L74. IF with postbiotics evaluated so far are safe and well tolerated by infants who cannot be breastfed. No firm conclusion can, however, be reached regarding the clinical effects and benefit of one formula over another. It seems reasonable to discuss with healthcare providers current evidence regarding specific modifications in infant formulas and let them decide whether the expected benefits meet expectations and are worth the cost.

Nutritional Management of Gastroesophageal Reflux Among Infants in the Philippines: Insights From Real-World Evidence

Background: The objective of the study was to describe the clinical course of infants with pediatrician-diagnosed gastroesophageal regurgitation (GER), after changing to an infant anti-regurgitation formula. Methods: Information on frequency and volume of regurgitation, and disease progression were collected from mothers of 0- to 12-month-old Filipino infants with GER at baseline and 1 month after a pediatrician prescribed-formula containing carob bean gum, galacto-oligosaccharides and partially hydrolyzed whey protein for 14 days. Results: Eighty-nine infants aged <= 6 months and 40 aged 7 - 12 months old were enrolled. The most frequently reported amount of baseline regurgitation was half of the total feed (29 (33%) younger infants and 17 (43%) older infants). Baseline regurgitation frequency ranged from 1 - 3 times/day (45 (51%) and 21 (52%)) to 4 - 6 times/day (33 (37%) and 14 (35%)) and 7 - 9 times/day (11 (12%) and five (13%)). Regurgitation after 1-day consumption was resolved in 16 (18%) and 8 (20%) and in 57 (64%) and 31 (78%) younger and older infants at 14 days. Forty-one (32%) infants still had regurgitation episodes after a 14-day trial with decreased frequency and volume; three (7%) infants did not show any improvement, while one (1%) infant had increased amount of regurgitation. No medicine was given to study participants. Parent-reported sleep disturbance decreased in three (37%) younger infants and 25 (63%) older infants. Conclusion: Nutrition intervention has effectively improved symptom and quality of life among infants with GER within 14 days. Information on underlying conditions among those with unresolved symptoms are needed. Int J Clin Pediatr. 2019;8(1):1-7 doi: https://doi.org/10.14740/ijcp338

P166 Gastro-esophageal reflux in infants: a cross-over evaluation of effectiveness of magnesium alginate vs anti-regurgitation formula

P166 Gastro-esophageal reflux in infants: a cross-over evaluation of effectiveness of magnesium alginate vs anti-regurgitation formula

Efficacy and Tolerance of a New Anti-Regurgitation Formula.

PurposeRegurgitation is a common physiological phenomenon in infants. The aim of the present study was to evaluate the efficacy of a new anti-regurgitation (AR) formula (Novalac), thickened with an innovative complex including fibres, on the daily number of regurgitations and to assess its impact on stool consistency and frequency.MethodsInfants younger than five months, presenting at least 5 regurgitations per day were recruited in this trial. The efficacy of the new formula on regurgitation (daily number and Vandenplas score), stool frequency and consistency were assessed at day 14 and 90. Growth data were recorded at each study visit.ResultsNinety babies (mean age 9.6±5.8 weeks) were included in the full analysis data set. The mean number of regurgitation episodes at inclusion was 7.3±3.4. In all infants, regurgitations improved after 2 weeks. The daily number of regurgitations decreased significantly (-6.3±3.3, p<0.001) including in those previously fed a thickened formula (-6.2±3.0, p<0.001). There was no significant change in stool consistency at day 14. After 3 months, 97.5% of infants had formed or soft stools. Growth was appropriate with a slight increase of weight-for-age z-score (from -0.5±1.0 to -0.1±0.9) and no change of weight-for length z-score (-0.1±1.1 to -0.1±-1.1).ConclusionThe new AR formula thickened with an innovative complex is very effective in reducing the daily number of regurgitations without having a negative impact on stools consistency.

The most common errors in the management of gastroesophageal reflux

Gastro-Esophageal Reflux (GER) occurs in more than two-thirds of otherwise healthy children and is one of the major reason for referral to paediatricians; in fact, a quarter of all paediatric visits in the first six months of life [1] and numerous accesses to the paediatric gastroenterologist services are secondary to GER. GER is defined as the passage of gastric contents into the esophagus and is different from gastroesophageal reflux disease (GERD), which includes all the symptoms and/or complications associated with GER [2]. GER is considered a physiological normal process which occurs several times a day in healthy infants, children and adults. GER is usually associated with transient lower esophageal sphincter relaxations independent from swallowing, which allow the passage of gastric contents into the esophagus. Episodes of GER in healthy adults tend to occur after meals, lasting less than three minutes and usually do not cause symptoms. Although we know less on the normal physiology of newborns and infants, regurgitation is the most visible symptom and tends to occur daily in 50% of all infants with a peak incidence between 4 and 6 months of life [3]. For the majority of paediatric patients (especially in infants), the clinical history and the objective appraisal, in the absence of danger signals, are sufficient to reliably diagnose a not complicated GER and initiate conservative treatment strategies; in general, the diagnostic tests are not always necessary. The reliability of the symptoms to make the clinical diagnosis of GERD is higher in children younger than 8 years, reporting heartburn: only in this case, the doctor can make a diagnosis of Gastro Esophageal Reflux Syndrome and give an indication for therapy [4]. To date, no single symptom or set of symptoms can be trusted, and then used to diagnose GERD in children or to predict which patients are more likely to respond to therapy [2]. The only exception is the child (age> 8y.o.) reporting a history of long-term heartburn with or without vomiting. The new ESPGHAN/NASPGHAN guidelines [2] describe different treatment options for the treatment of infants / children with GER and GERD. In particular, they emphasized the changes in lifestyle, because it can effectively reduce the symptoms of both infants and children. They are based on a combination of changes of milk formulas and positional therapy. In infants with GER, it can be effective the changes to the mother's diet if children are breastfed, change the formula in use, reducing the volume of the single meal associated with an increased frequency of feedings. In particular, the guidelines stress that the allergy to milk proteins may have a clinical presentation similar to GERD. A strategy of nutritional intervention involves the use of thickened formulas that are able to decrease the regurgitation. A recent meta-analysis has shown that the anti regurgitation formula have the following functions: a) increase the number of infants without regurgitation; b) reduce the number of episodes of regurgitation and vomiting daily; c); increase the weight recovery of the infant, d) although they do not change the 24 hours pH study [4].

Gastroesophageal reflux in children

Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and is a normal physiologic process occurring several times per day in healthy individuals. In older children and adolescents, history and physical examination may be sufficient to diagnose gastroesophageal reflux disease (GERD).Endoscopically-visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Esophageal pH monitoring quantitatively measures esophageal acid exposure. Combined multiple intraluminal impedance and pH monitoring (MII-pH) measures acidic, weakly acidic, non-acidic and gas reflux episodes. MII-pH is superior to pH monitoring alone for evaluation of the temporal relationship between symptoms and GERER. Barium contrast radiography is not useful for the GERERD diagnosis, but may be used to detect anatomic abnormalities. Parental education, guidance, and support are always required and usually sufficient to manage healthy, thriving infants with symptoms likely due to physiologic GERER. Use of a thickened, commercially available anti-regurgitation formula by preference, may decrease visible regurgitation. Buffering agents, alginate and sucralfate, can be beneficial if used as needed for occasional heartburn. Proton-pump inhibitors (PPIs) are superior to histamine-2 receptor antagonists (H2RAs).

Gastro-esophageal reflux in children:Symptoms, diagnosis and treatment

Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and is a normal physiologic process occurring several times per day in healthy individuals. In infants and toddlers, no symptoms allow to diagnose GERD or to predict response to therapy. In older children and adolescents, history and physical examination may be sufficient to diagnose GERD. Endoscopically visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Esophageal pH monitoring quantitatively measures esophageal acid exposure. The severity of pathologic acid reflux does not predict symptom severity or treatment outcome. Combined multiple intraluminal impedance and pH monitoring (MII-pH) measures both acid, weakly acid, non-acid and gas reflux episodes. MII-pH is superior to pH monitoring alone for evaluation of the temporal relationship between symptoms and GER. Barium contrast radiography is not useful for the diagnosis of GERD, but is useful to detect anatomic abnormalities. Tests on ear, lung and esophageal fluids for lactose, pepsin or lipid laden macrophages have all been proposed without convincing evidence. An empiric trial of acid suppression as a diagnostic test can be used in older children (> 10 years). Parental education, guidance and support are always required and usually sufficient to manage healthy, thriving infants with symptoms likely due to physiologic GER. Use of a thickened feed, by preference commercially available anti-regurgitation formula, decrease visible regurgitation. Positional therapy brings additional benefit. Prone (beyond the age of sudden infant death syndrome) or left side sleeping position, and/or elevation of the head of the bed decrease GER. Chronic use of buffering agents or sodium alginate is not recommended for GERD since some have absorbable components that may have adverse effects with long-term use. Potential adverse effects of currently available prokinetic agents outweigh the potential benefits of these medications for treatment of GERD. Proton pump inhibitors (PPIs) are superior to histamine-2 receptor antagonists (H2RAs). Administration of long-term acid suppression without a diagnosis is not recommended. No PPI has been approved for use in infants < 1 year of age. The potential adverse effects of acid suppression, including increased risk of community-acquired pneumonias and gastrointestinal infections, need to be balanced against the benefits of therapy. Anti-reflux surgery is of benefit in selected children with chronic, relapsing GERD. Indications include failure of optimized medical therapy; dependence on long-term medical therapy; significant non-adherence with medical therapy; or pulmonary aspiration of refluxate.

Liquid Barium is not Representative of Infant Formula: Characterisation of Rheological and Material Properties

Infants experiencing dysphagia may undergo a videofluoroscopic swallow study (VFSS) to assess radiologically their coordination for sucking, swallowing, and breathing. No studies known to these authors have investigated whether the liquids used during infant radiological procedures are representative of liquids routinely fed to infants (e.g., formula). This study used an Advanced Rheometric Expansion System (ARES) strain-controlled rheometer to compare prethickened antiregurgitation formula, regular (thin) infant formula, and two types of regular infant formula, hand-thickened with a thickening agent and with liquid Polibar™ (barium-impregnated liquid). The viscosity, density, and yield stress of all samples were determined. Heated versus cooled liquids were compared. Results showed a significant difference in all rheological and material property parameters among the barium-impregnated liquids and the thickened and unthickened infant formula. This finding has important implications for the interpretation of the radiological results and subsequent clinical recommendations.

P1018 GASTROESOPHAGEAL REFLUX: EXPERIENCE OF TUNISIAN PRIVATE PAEDIATRICIANS

Introduction: The aim of this study is t report diagnosis and therapeutic experience of Tunisian private paediatricians in children gastroesophageal reflux (GER). Methods: an anonymous questionnaire is send to 180 private paediatricians with 22 questions about positive diagnosis, therapeutic and evolution of GER. Results: One hundred and two (57%) paediatricians responded to the questionnaire (Age: 44.5 + 6 years, duration of practical experience: 13.5 + 6,4 years). According to all, the 2 principal symptoms evocating GER are vomiting and recurrent bronchitis. In they practical experience, 60% of children with GER have typical symptoms. To explore children, paediatricians have more facility to use ultrasound and radiological investigation (90%), than PH metry (24%). Only 20% of paediatricians explored systematically all children who suspected suffering from GER. To confirm GER diagnosis, paediatricians use especially ultrasound (47%) or PH metry (36%). Among the dietetic measurements, paediatricians especially recommended anti regurgitation formula (87%) and the thickening of meal (83%). Positional therapeutic is recommended by majority of paediatricians (90%). All paediatricians prescribe prokinetic drugs: cesapridâ (46%), metochlopramidâ (34%). They also use anti acid (especially alginate of sodium) 85%, anti H2 drugs (53%) and Proton pump inhibitors (PPI) (49%). Only one paediatrician systematically prescribe PPI, the others use PPI in oesophagitis or in case of prokinietic treatment failure. 77% of paediatricians are satisfied with treatment respond. They estimate about 12% children need prolonged treatment (over 18 months). The complications reported are especially recurrent bronchitis (50%), oesophagitis ((39%), and failure to thrive (18%). 40% of paediatricians have indicated surgical treatment in one children at least. Conclusion: This study shown no respect of GER recommendation in some investigation and therapeutic aspects. Comparison of these data and GER experience of other countries may be interesting.

A critical appraisal of current management practices for infant regurgitation--recommendations of a working party.

Regurgitation is a common manifestation in infants below the age of 1 year and a frequent reason of counselling of general practitioners and paediatricians. Current management starts with postural and dietary measures, followed by antacids and prokinetics. Recent issues such as an increased risk of sudden infant death in the prone sleeping position and persistent occult gastro-oesophageal reflux in a subset of infants receiving milk thickeners or thickened "anti-regurgitation formula" challenge the established approach. Therefore, the clinical practices for management of infant regurgitation have been critically evaluated with respect to their efficacy, safety and practical implications. The updated recommendations reached by the working party on the management of infant regurgitation contain five phases: (1 A) parental reassurance; (1 B) milk-thickening agents; (2) prokinetics; (3) positional therapy as an adjuvant therapy; (4 A) H2-blockers; (4 B) proton pump inhibitors; (5) surgery.