Gastroesophageal Reflux In Infants Research Articles

ANTISECRETORY TREATMENT FOR PEDIATRIC GASTROESOPHAGEAL REFLUX DISEASE - A SYSTEMATIC REVIEW.

Proton pump inhibitors and histamine H2 receptor antagonists are two of the most commonly prescribed drug classes for pediatric gastroesophageal reflux disease, but their efficacy is controversial. Many patients are treated with these drugs for atypical manifestations attributed to gastroesophageal reflux, even that causal relation is not proven. To evaluate the use of proton pump inhibitors and histamine H2 receptor antagonists in pediatric gastroesophageal reflux disease through a systematic review. A systematic review was performed, using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases. The search was limited to studies published in English, Portuguese or Spanish. There was no limitation regarding date of publication. Studies were considered eligible if they were randomized-controlled trials, evaluating proton pump inhibitors and/or histamine H2 receptor antagonists for the treatment of pediatric gastroesophageal reflux disease. Studies published only as abstracts, studies evaluating only non-clinical outcomes and studies exclusively comparing different doses of the same drug were excluded. Data extraction was performed by independent investigators. The study protocol was registered at PROSPERO platform (CRD42016040156). After analyzing 735 retrieved references, 23 studies (1598 randomized patients) were included in the systematic review. Eight studies demonstrated that both proton pump inhibitors and histamine H2 receptor antagonists were effective against typical manifestations of gastroesophageal reflux disease, and that there was no evidence of benefit in combining the latter to the former or in routinely prescribing long-term maintenance treatments. Three studies evaluated the effect of treatments on children with asthma, and neither proton pump inhibitors nor histamine H2 receptor antagonists proved to be significantly better than placebo. One study compared different combinations of omeprazole, bethanechol and placebo for the treatment of children with cough, and there is no clear definition on the best strategy. Another study demonstrated that omeprazole performed better than ranitidine for the treatment of extraesophageal reflux manifestations. Ten studies failed to demonstrate significant benefits of proton pump inhibitors or histamine H2 receptor antagonists for the treatment of unspecific manifestations attributed to gastroesophageal reflux in infants. Proton pump inhibitors or histamine H2 receptor antagonists may be used to treat children with gastroesophageal reflux disease, but not to treat asthma or unspecific symptoms.

Influence of bouncing and assisted autogenic drainage on acid gastro-oesophageal reflux in infants.

To determine the influence of modern airway clearance techniques using assisted autogenic drainage (AAD), whether or not combined with bouncing, on acid gastro-oesophageal reflux (GOR) in infants <1 year. In this controlled trial with intra-subject design infants were studied using oesophageal pH monitoring over 24 h, during which they received one 15 min session of bouncing, AAD or bouncing combined with AAD (BAAD). The number of reflux episodes (RE) and the refluxindex (RI) were the outcome measures. The results obtained during (T15) and 15 min after the intervention (T30) were compared to a period of 15 min before treatment (T0). The results of 150 infants, evenly distributed over the three treatment groups, were analyzed. No significant differences were found in number of RE at T15 and T30 compared to T0 in the bouncing group (P = 0.42), the AAD group (P = 0.14), and the BAAD group (P = 0.91). RI was significantly lower in the AAD group at T15 compared to T0 (P < 0.01). No differences in RI were found in the bouncing group (P = 0.28), nor in the BAAD group (P = 0.81). Bouncing, AAD and BAAD do not induce, nor aggravate acid GOR in infants under the age of 1 year.

Parental Concerns on Gastroesophageal Reflux

Parents often perceive infant gastroesophageal reflux (GER) as a serious problem. Frequently, GER is explained as a normal process, but there are instances where parents’ concerns are valid. Provided are 3 case studies from the private practice of an IBCLC. Each case initially presented with what sounded like normal infant GER. Upon further evaluation, with close follow-up and more detailed history taking, each case required advanced medical attention. These cases highlight the unique role of the IBCLC in helping to assess GER, the value of working as a team member with baby’s physicians, and the importance of listening carefully to parental instincts and concerns.

Breastfeeding improvement following tongue-tie and lip-tie release: A prospective cohort study.

Objectives/HypothesisNumerous symptoms may arise that prevent mother‐infant dyads from maintaining desired breastfeeding intervals. Investigations into treatments that positively influence breastfeeding outcomes allow for improved patient counseling for treatment decisions to optimize breastfeeding quality. This investigation aimed to determine the impact of surgical tongue‐tie/lip‐tie release on breastfeeding impairment.Study DesignProspective, cohort study from June 2014 to April 2015 in a private practice setting.MethodsStudy participants consisted of breastfeeding mother–infant (0–12 weeks of age) dyads with untreated ankyloglossia and/or tethered maxillary labial frenula who completed preoperative, 1 week, and 1 month postoperative surveys consisting of the Breastfeeding Self‐Efficacy Scale‐Short Form (BSES‐SF), visual analog scale (VAS) for nipple pain severity, and the revised Infant Gastroesophageal Reflux Questionnaire (I‐GERQ‐R). Breastmilk intake was measured preoperatively and 1 week postoperatively.ResultsA total of 237 dyads were enrolled after self‐electing laser lingual frenotomy and/or maxillary labial frenectomy. Isolated posterior tongue‐tie was identified in 78% of infants. Significant postoperative improvements were reported between mean preoperative scores compared to 1 week and 1 month scores of the BSES‐SF (F (2) = 212.3; P < .001), the I‐GERQ‐R (F (2) = 85.3; P < .001), and VAS pain scale (F (2) = 259.8; P < .001). Average breastmilk intake improved 155% from 3.0 (2.9) to 4.9 (4.5) mL/min (P < .001).ConclusionsSurgical release of tongue‐tie/lip‐tie results in significant improvement in breastfeeding outcomes. Improvements occur early (1 week postoperatively) and continue to improve through 1 month postoperatively. Improvements were demonstrated in both infants with classic anterior tongue‐tie and less obvious posterior tongue‐tie. This study identifies a previously under‐recognized patient population that may benefit from surgical intervention if abnormal breastfeeding symptoms exist.Level of Evidence2c Laryngoscope, 127:1217–1223, 2017

Current Insights into the Pharmacologic and Nonpharmacologic Management of Gastroesophageal Reflux in Infants

Gastroesophageal reflux is common and, in most cases, is a self-limited and physiologic process in infants. However, the role of diagnostic testing and pharmacologic interventions in reflux remains controversial among providers. Various diagnostic modalities exist, but most infants do not require invasive testing and many symptoms traditionally attributed to reflux show no correlation on further testing. There are many strategies for managing reflux in infants. Nonpharmacologic approaches include positioning, thickening, changing formulas, and changing the frequency of feedings, with the benefits of these methods shown to be inconsistent. Many medications now exist to address reflux, particularly by way of acid suppression, but these pharmacologic interventions have risks, especially in young infants, and many of these therapies have shown limited success in truly reducing reflux symptoms. In conclusion, nonpharmacologic approaches should be used, because most symptoms of gastroesophageal reflux will ultimately resolve without any intervention.

Tu1748 Gastroesophageal Reflux Symptoms in Healthy Infants Measured by the Infant Gastroesophageal Reflux Questionnaire Revised (I-Gerq-R): A Cross-Sectional Study

Tu1748 Gastroesophageal Reflux Symptoms in Healthy Infants Measured by the Infant Gastroesophageal Reflux Questionnaire Revised (I-Gerq-R): A Cross-Sectional Study

Influence of intrapulmonary percussive ventilation in upright position on gastro-oesophageal reflux in infants.

To determine the influence of physiotherapy using intrapulmonary percussive ventilation on gastro-oesophageal reflux (GOR) in infants <1 year. In this controlled trial with intra-subject design, children were studied using multichannel intraluminal impedance pH (pH-MII) monitoring over 24 hr, during which they received one 20-min session of intrapulmonary percussive ventilation in upright position (IPVR ), 2 hr after their latest feeding. Two hours after each feeding, the number of reflux episodes (RE) over a 20-min period was registered for each infant and a mean per 20 min was calculated in order to obtain a baseline value. The number of RE during IPVR intervention was compared to baseline. Fifty infants with a median age of 133 days were recruited of whom 21 were diagnosed with pathological GOR. During IPVR , the incidence of RE in the entire group was significantly lower compared to baseline; median (inter-quartile range [IQR]) 0 (0-1) versus 0.71 (0-1.33) RE, respectively, P = 0.003. The subgroup with abnormal GOR showed also a significant decrease of RE during IPVR ; median (IQR) 0 (0-1) versus 1.17 (0.55-2.16) RE, respectively, P = 0.03. No difference was detected in the group with normal reflux; median (IQR) 0.6 (0-1) compared to 0 (0-1) RE, respectively, P = 0.34. IPVR does not induce, nor aggravate GOR in infants without and with pathological GOR, respectively, but on the contrary decreases the number of RE in patients with pathological reflux. Pediatr Pulmonol. 2016;51:1065-1071. © 2016 Wiley Periodicals, Inc.

Favorable Effect of Rikkunshito on Gastroesophageal Reflux in Infants

Favorable Effect of Rikkunshito on Gastroesophageal Reflux in Infants

Infant Gastroesophageal Reflux Information on the World Wide Web

IntroductionThe purpose of this study was to describe the type and quality of health information about infant gastroesophageal reflux (GER) that a parent may find on the World Wide Web. MethodsThe data collection tool included evaluation of Web site quality and infant GER-specific content on the 30 sites that met the inclusion criteria. ResultsThe most commonly found content categories in order of frequency were management strategies, when to call a primary care provider, definition, and clinical features. The most frequently mentioned strategies included feeding changes, infant positioning, and medications. Thirteen of the 30 Web sites included information on both GER and gastroesophageal reflux disease. Mention of the use of medication to lessen infant symptoms was found on 15 of the 30 sites. Only 10 of the 30 sites included information about parent support and coping strategies. DiscussionPediatric nurse practitioners (PNPs) should utilize well-child visits to address the normalcy of physiologic infant GER and clarify any misperceptions parents may have about diagnosis and the role of medication from information they may have found on the Internet. It is critical for PNPs to assist in the development of Web sites with accurate content, advise parents on how to identify safe and reliable information, and provide examples of high-quality Web sites about child health topics such as infant GER.

Infant gastro-oesophageal reflux disease (GORD): Australian GP attitudes and practices.

The aim of this study was to evaluate the attitudes and practices of Australian general practitioners (GPs) regarding infant gastro-oesophageal reflux disease (GORD) diagnosis and management. A national cross-sectional survey, involving a random sample of currently practising Australian GPs (n = 2319) was undertaken between July and September 2011. GPs attitudes and management of infant GORD were surveyed via an online and paper-based 41-item questionnaire. In total, 400 responses were analysed (17.24% response rate). The majority of GPs employed empirical trials of acid-suppression medication and/or lifestyle modifications to diagnose infant GORD. GPs frequently recommended dietary modification despite the belief that they were only moderately effective at best. In addition, GPs frequently prescribed acid-suppression medication, despite concerns regarding their safety in the infant population. Other GP concerns included the lack of clinical guidelines and education for GPs about infant GORD, as well as the level of evidence available for the safety and efficacy of diagnostic tests and treatments. Despite the important role Australian GPs play in the diagnosis and management of infant GORD, high-level evidence-based guidelines for GPs are lacking. Consequently, GPs engage in diagnostic and management practices despite their concerns regarding the safety and effectiveness.

Influence of respiratory physiotherapy on gastro-oesophageal reflux in infants: A systematic review

To provide a survey on the literature concerning the influence of respiratory physiotherapy on gastro-oesophageal reflux (GOR) in infants and young children. Electronic databases (Pubmed, Web of Science, PEDro) and reference lists of articles and narrative reviews were searched. Articles were included when infants and small children underwent oesophageal pH monitoring or pH-multichannel intraluminal impedance monitoring while respiratory physiotherapy was administered. Descriptive analysis was performed and two researchers scored the methodological quality of these studies. Out of 985 articles, seven (six English, one French) have been included, In total 277 patients were involved, 71 with cystic fibrosis. Depending on the technique used, four studies showed GOR to be aggravated during therapy, three studies reported no effect. The evidence is not conclusive on whether respiratory physiotherapy induces or aggravates GOR in infants and small children. Age, disease, and treatment options play an important role. More specific research, also focussing on the influence of respiratory physiotherapy on non-acid reflux and the impact of recently developed airway clearance techniques (ACT's) on GOR is necessary.

G364(P) Management of gastroesophageal reflux in infants: current practice of diagnosis and treatment in a uk district general hospital

Objectives and study According to current ESPGHAN and NASPGHAN guidelines, gastroesophageal reflux (GER) is defined as the passage of gastric contents into the oesophagus with or without regurgitation and vomiting. GER is considered to be physiological in the majority of young infants under the age of 12 months. Typically, episodes of GER in healthy individuals last Aim of the study The aim of this study was to assess current clinical practice and adherence to ESPGHAN guidelines regarding the diagnosis and management of infants presenting with symptoms of GER/GERD. Methods Medical records of 60 patients treated in an inpatient or outpatient setting, age 1 day to 1 year and with a diagnosis of GOR or GORD were randomly collected. Data recorded for each patient included: specific diagnosis, presence of clinical symptoms suggestive of GOR/GORD, choice of treatment and if the diagnostic criteria according to ESPGHAN guidelines were met. Results In total 100% of patients included in this study were diagnosed with GOR, rather than GORD despite the presence of what could be considered as “troublesome symptoms”. The two most frequently reported symptoms were poor weight gain n = 6 (10%) and irritability n = 40 (66%). Importantly, despite being “officially” diagnosed with GOR, 55 out of 60 children (91%) were commenced on anti-reflux medication (i.e. proton pump inhibitors or the H2 receptor blocker Ranitidine). All parents were provided with education and guidance. Conclusion Our small study provides insight into current clinical practice in a district general hospital and highlights major insufficiency in the understanding and management of GOR/GORD. Despite diagnosing GOR the majority of infants are commenced on medical treatment. Active advice and teaching to healthcare professionals in the primary and secondary sector is required to improve the situation in the long term.

Standard (head-down tilt) versus modified (without head-down tilt) postural drainage in infants and young children with cystic fibrosis.

Postural drainage is used primarily in infants with cystic fibrosis from diagnosis up to the moment when they are mature enough to actively participate in self-administered treatments. However, there is a risk of gastroesophageal reflux associated with this technique. To compare the effects of standard postural drainage (greater (30° to 45° head-down tilt) and lesser (15° to 20° head-down tilt)) with modified postural drainage (greater (30º head-up tilt) or lesser (15º to 20º head-up tilt)) with regard to gastroesophageal reflux in infants and young children up to six years old with cystic fibrosis in terms of safety and efficacy. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register. We also searched the reference lists of relevant articles and reviews. Additional searches were conducted on ClinicalTrials.gov and on the WHO International Clinical Trials Registry Platform for any planned, ongoing and unpublished studies.The date of the most recent literature searches: 20 January 2015. We included randomised controlled studies that compared two postural drainage regimens (standard and modified postural drainage) with regard to gastroesophageal reflux in infants and young children (up to and including six years old) with cystic fibrosis. Two review authors independently selected the studies to be included in the review, assessed their risk of bias and extracted data. Two studies, including 40 participants, were eligible for inclusion in the review. The studies were different in terms of the age of participants, the angle of tilt, the reported outcomes, the number of sessions and the study duration. The following outcomes were measured: appearance or exacerbation of gastroesophageal reflux episodes; percentage of peripheral oxygen saturation; number of exacerbations of upper respiratory tract symptoms; number of days on antibiotics for acute exacerbations; chest X-ray scores; and pulmonary function tests. One study reported that postural drainage with a 20° head-down position did not appear to exacerbate gastroesophageal reflux. However, the majority of the reflux episodes reached the upper oesophagus. The second included study reported that modified postural drainage (30º head-up tilt) was associated with fewer number of gastroesophageal reflux episodes and fewer respiratory complications than standard postural drainage (30º head-down tilt). The included studies had an overall low risk of bias. Data were not able to be pooled by meta-analysis due to differences in the statistical presentation of the data. The available evidence regarding the comparison between the two regimens of postural drainage is still weak due to the small number of included studies, the small number of participants assessed, the inability to perform any meta-analyses and some methodological issues with the studies. However, it may be inferred that the use of a postural regimen with a 30° head-up tilt is associated with a lower number of gastroesophageal reflux episodes and fewer respiratory complications in the long term. The 20º head-down postural drainage position was not found to be significantly different from the 20º head-up tilt modified position. Nevertheless, the fact that the majority of reflux episodes reached the upper oesophagus should make physiotherapists carefully consider their treatment strategy.

Effect of magnesium alginate plus simethicone on gastroesophageal reflux in infants: A randomized, open trial

Objectives: Gastroesophageal reflux (GER) is a frequent condition in infants that can cause distressing symptoms. The aim of our study is to evaluate the efficacy of Mg-alginate plus simethicone (Gastrotuss Baby®), compared to rice-starch-thickened formula or to reassurance alone, in the treatment of GER in infants.

Esophageal high resolution manometry in neurologically impaired children and gastro-oesophageal reflux disease

s / Digestive and Liver Disease 46 (2014) e71–e84 e81 genotyped by DMET technology, with colon cancer and GI toxicity induced by irinotecan. Conclusions: In conclusion, according to our preliminary findings, the heterozygous genotype G/A in the (rs55802895) NR1I3 gene seems to be associated with the altered gastrointestinal function in FD. http://dx.doi.org/10.1016/j.dld.2014.07.043 EFFECT OF MAGNESIUM ALGINATE PLUS SIMETHICONE ON GASTROESOPHAGEAL REFLUX IN INFANTS: A RANDOMIZED, OPEN TRIAL Dario Ummarino ∗, Erasmo Miele, Massimo Martinelli, Elena Scarpato, Felice Crocetto, Elisa Sciorio, Annamaria Staiano Dipartimento di Scienze Mediche Traslazionale, Sezione Pediatria, Universita degli Studi di Napoli Federico II, Napoli, Italy Objectives: Gastroesophageal reflux (GER) is a frequent condition in infants that can cause distressing symptoms. The aim of our study is to evaluate the efficacy of Mg-alginate plus simethicone (Gastrotuss Baby®), compared to rice-starch-thickened formula or to reassurance alone, in the treatment of GER in infants. Methods: This randomized, controlled trial was conducted in full-term infants affected by symptoms suggestive of GER, evaluated through a validated questionnaire (I-GERQ-R). The patients were randomized in3groups according to treatment [GroupA:Mgalginate plus simethicone (Gastrotuss Baby®); Group B: Thickened formula; Group C: reassurance with lifestyle changes]. The evaluation of the symptom scores was performed after one month (T1) and two months (T2). Results: Sixty-four (85.3%) out of 75 enrolled infants (median age: 5 months; range: 1–10), concluded the study. After one month of treatment (T1), infants treated with Mg-alginate plus simethicone (Gastrotuss Baby®) showed a statistically significant improvement of symptoms compared with the thickened formula and reassurance (p 24 months (p 0.0001) and was similar in the two decades. Conclusions: Our study showed that IFALD occurs early in the natural history of SBS. This suggests that it may depend on the underlying disease and on its early complications (repeated surgery, sepsis) rather than the factors related to the PN duration. This is also supported by the evidence of the unchanged prevalence of IFALD over the years in spite of advances in the PNmanagement. http://dx.doi.org/10.1016/j.dld.2014.07.045 WAIST TO HEIGHT RATIO: A SIMPLE TOOL TO RECOGNISE CHILDREN AT INCREASED RISK FOR METABOLIC SYNDROME Angelo Campanozzi1,∗, Irene Rutigliano1, Donatella De Giovanni1, Michela Foglia1, Mariangela Guglielmi1, Gianpaolo De Filippo2, Luciana Romaniello1, Valentina De Maio1, Michele Conoscitore1, Massimo Pettoello-Mantovani1 1 Clinica Pediatrica, Universita’ di Foggia, Foggia, Italy 2 Pediatria, Ospedale Bicetre, Parigi, France Objective: Metabolic Syndrome (MS) is the most important comorbidity obesity-related, also in children. Visceral adiposity is part of MS cluster, so that measurement of Waist Circumference (WC) is an essential step for screening MS in adulthood and childhood. Up today, valid cut-off percentiles for WC are not available for the whole pediatric population, arising difficulties to diagnose the MS. Aim of the study: To individuate a simple clinical diagnostic tool for screening obese children at risk for MS. Methods:Weenrolled in the study803 subjects (395girls,mean age 9.43±2.5 yrs) whose mean BMI z-score was 2.2±0.53. The

Body positioning and medical therapy for infantile gastroesophageal reflux symptoms.

Proton-pump inhibitors (PPIs) reduce acid gastroesophageal reflux (GER) and esophageal acid exposure in infants; however, they do not reduce total GER or symptoms attributed to GER. Reflux is reduced in the left lateral position (LLP). We hypothesize that the effect of LLP in combination with acid suppression is most effective in reducing GER symptoms in infants. In this prospective sham-controlled trial, infants (0-6 months) with symptoms suggestive of gastroesophageal reflux disease were studied using 8-hour pH-impedance, cardiorespiratory and video monitoring, direct nurse observation, and a validated questionnaire. Infants demonstrating a positive GER symptom association were randomized to 1 of 4 groups; PPI + LLP, PPI + head of cot elevation (HE), antacid (AA) + LLP, or AA + HE. HE and AA were considered "sham" therapies. After 2 weeks the 8-hour studies were repeated on-therapy. Fifty-one patients were included (aged 13.6 [2-26] weeks). PPI + LLP was most effective in reducing GER episodes (69 [13] to 46 [10], P < 0.001) and esophageal acid exposure (median [interquartile range] 8.9% [3.1%-18.1%] to 1.1% [0%-4.4%], P = 0.02). No treatment group showed improvement in crying/irritability, although vomiting was reduced in AA + LLP (from 7 [2] to 2 [0] episodes P = 0.042). LLP compared with HE produced greater reduction in total GER (-21 [4] vs -10 [4], P = 0.056), regardless of acid-suppressive therapy. Acid exposure was reduced on PPI compared with AA (-6.8 [2.1] vs -0.9 [1.4]%, pH < 4, P = 0.043) regardless of positional intervention. A post-hoc analysis using automated analysis software revealed a significant reduction in crying symptoms in the PPI + LLP group (99 [65-103] to 62 [32-96] episodes, P = 0.018). "Symptomatic gastroesophageal reflux disease" implies disease causation for distressing infant symptoms. In infants with symptoms attributed to GER, LLP produced a significant reduction in total GER, but did not result in a significant improvement in symptoms other than vomiting; however, automated analysis appeared to identify infants with GER-associated crying symptoms who responded to positioning therapy. This is an important new insight for future research.

GERD: body position affects infant GER but not symptoms.

Increased gastro-oesophageal reflux (GER) is described as a very common problem in infants. Loots et al. investigated the effect of the left lateral position on reflux and symptoms, finding that body position affects GER but not symptoms. The data highlight the difficulties faced in investigating reflux disease in the paediatric population.

Interactions during feeding with mothers and their infants with symptoms of gastroesophageal reflux.

To examine whether maternal-child interaction during feedings was suboptimal in dyads in which the infant had gastroesophageal reflux disease (GERD) and to compare massage therapy to a nonmassage therapy sham treatment in improving the mother-child interaction in these dyads. In this randomized, controlled pilot study, infants received massage therapy (n=18) or a nonmassage touch/holding sham treatment (n=18). Mothers, data collectors, and the investigator who scored the feeding observations were blinded to group assignment. Dyads were recruited from pediatric care providers in the Denver metropolitan area and online advertisements at the University of Colorado. Treatments were given in the home of the dyad. Healthy infants, born at 38-42 weeks gestational age, were 5-10 weeks of age at enrollment; had a score of at least 16 on the Infant Gastroesophageal Reflux Questionnaire-Revised; and were diagnosed with GERD by their pediatric provider. Mothers were English speaking and at least 18 years of age. Treatments were given for 30 minutes twice weekly for 6 weeks. A certified infant massage therapist administered massage, and a registered nurse or physical therapist experienced with infants administered the control treatment. Maternal and infant scores on the Nursing Child Assessment of Feeding Scale (NCAFS). NCAFS scores were significantly lower than national norms. Small to moderately sized effects showing improvement in the massage group relative to the nonmassage group were seen for Sensitivity to Cues, Social-Emotional Growth Fostering, Cognitive Growth Fostering, and Clarity of Cues (Cohen d) and ranged from 0.24 to 0.56. Mothers and infants with GERD experience significantly worse interactions than those without GERD. Massage given twice weekly by a professional trended toward improved interaction during feeding. Daily maternal administration of massage may have a positive effect on the relationship.

Gastro-oesophageal reflux in infants: A common concern for parents

This article will examine the most recent definitions for gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD). It will identify common symptoms seen in infants and explore potential investigations that may be required. There are a variety of treatment options available, and the health visitor has a significant role in taking appropriate history, referring parents to fellow health professionals and providing support for families. This article will discuss important points to consider when engaging with families where GOR/GORD may be of concern.

Safety and Efficacy of Delayed Release Rabeprazole in 1‐ to 11‐Month‐Old Infants With Symptomatic GERD

: The efficacy and safety of rabeprazole, a proton pump inhibitor, were studied in infants with gastroesophageal reflux disease (GERD). Infants ages 1 to 11 months, with symptomatic GERD resistant to conservative therapy and/or previous exposure to acid-suppressive medications, were screened. After scoring >16 on a GERD symptom score (Infant Gastroesophageal Reflux Questionnaire-Revised [I-GERQ]), 344 infants were enrolled in a 1- to 3-week open-label (OL) phase and received rabeprazole 10 mg/day. Following caregiver-rated clinical improvement during the OL phase, patients were randomized to placebo, rabeprazole 5 mg, or rabeprazole 10 mg in the ensuing 5-week double-blind (DB) withdrawal phase. Primary endpoints evaluated from DB baseline to the end of the DB withdrawal phase included frequency of regurgitation, weight-for-age z score, and daily and weekly GERD symptom scores. Overall, 231 (86%) of the 268 randomized infants (placebo: 90; rabeprazole 5 mg: 90; rabeprazole 10 mg: 88) completed the study. Efficacy endpoints were similarly improved during the OL phase in all of the groups, and continued improving during the DB withdrawal phase with no difference between the placebo and combined rabeprazole groups. Mean decrease in frequency of regurgitation (-0.79 vs -1.20 times per day; P = 0.168), in I-GERQ-Revised scores (-3.6 [-25%] vs -3.9 points [-27%]; P = 0.960), in I-GERQ-Daily Diary scores (-1.87 [-19%] vs -1.85 [-19%]; P = 0.968), and increase in weight-for-age z scores (mean [standard deviation]: 0.11 [0.329] vs 0.14 [0.295]; P = 0.440) indicated equal improvement. Equal percentages (47%) reported adverse events in placebo and combined rabeprazole groups, with no new safety signals emerging. In those infants with GERD who improved with rabeprazole during the OL phase, improvements in symptoms and weight were similar in those who continued rabeprazole and those withdrawn to placebo during a 5-week DB phase.