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Vandenplas Y, Orsi M, Benninga M, Gatcheco F, Rosen R, Thomson M. Infant gastroesophageal reflux disease management consensus. Acta Paediatr 2024; 113:403-410. [PMID: 38116947 DOI: 10.1111/apa.17074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023]
Abstract
AIM Infant gastroesophageal reflux is mostly benign; however, when associated with complications like failure to thrive, it may be indicative of gastroesophageal reflux disease. There are currently several unmet needs pertaining to the management of infant gastroesophageal reflux (disease). Reflux in infants is mostly composed of breast milk or formula, so this population is significantly different to older children and adults. The objective of this Delphi consensus was to establish recommendations based on published literature and the experience of clinical experts in paediatric gastroenterology in the context of infant gastroesophageal reflux (disease). METHODS The Delphi methodology was used to obtain a consensus on 18 statements relating to clinical aspects of infant gastroesophageal reflux (disease). RESULTS The expert panel comprising paediatric gastroenterology clinical specialists reached a consensus for all statements by means of an online, anonymised voting system. CONCLUSION It was highlighted that there is generally low awareness of or adherence to guidelines in clinical practice and that acid suppression therapy should not be indicated for non-acid reflux, which constitutes a significant proportion of total gastroesophageal reflux episodes among infants. Furthermore, it was emphasised that there is an unmet medical need for therapy for some symptomatic infants with non-acid reflux disease.
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Affiliation(s)
- Yvan Vandenplas
- Department of Pediatrics, Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Brussels, Belgium
| | - Marina Orsi
- Pediatric Gastroenterology, Hepatology & Transplant Unit, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Marc Benninga
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
| | - Felizardo Gatcheco
- Department of Pediatrics, Manila Central University Hospital, Caloocan, Philippines
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mike Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Weston Bank, Sheffield, UK
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2
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Closs ER, Mårild K, Nielsen RG, Størdal K. Use of proton pump inhibitors in scandinavian children and adolescents: An observational study. Front Pediatr 2023; 11:1052978. [PMID: 36873656 PMCID: PMC9978809 DOI: 10.3389/fped.2023.1052978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/20/2023] [Indexed: 02/18/2023] Open
Abstract
AIMS To examine the use of proton pump inhibitors (PPIs) in Scandinavian children with focus on the geographical variation, temporal changes and possible contributing factors to observed changes. METHODS An observational population-based study of children and adolescents (1-17 years) in Norway, Sweden, and Denmark during the period 2007-2020. Information concerning dispensed PPIs was obtained from the national prescription databases of each country and presented as means per 1,000 children for each country and calendar year in four age categories (1-4, 5-9, 10-13 and 14-17 years). RESULTS In 2007, the PPI use in children was similar across Scandinavian countries. An increased PPI use was observed in all countries during the study period, with gradually increasing differences between the countries. In general, Norway showed both the largest total increase and the largest increase in each age category compared to Sweden and Denmark. In 2020 Norwegian children showed, on average, a 59% higher PPI use compared to Swedish children and a more than double the overall dispensation rate than Denmark. In Denmark there was a 19% reduction in dispensed PPIs from 2015 to 2020. CONCLUSION Despite being countries with similar health care systems and without indications of increased incidence of gastroesophageal reflux disease (GERD), we observed considerable geographical variation and temporal changes of PPI use in children. Although this study did not contain data on the indication for PPI use, these large differences across countries and time may indicate a current overtreatment.
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Affiliation(s)
| | - Karl Mårild
- Department of Pediatrics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Pediatric Gastroenterology, Queen Silvia Children's hospital, Gothenburg, Sweden
| | | | - Ketil Størdal
- Department of Pediatric Research, University of Oslo, Oslo, Norway.,Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Yang S, Trinh NTH, Chalumeau M, Kaguelidou F, Ruemmele FM, Milic D, Lemaitre M, Cohen JF, Taine M. Pediatric Prescriptions of Proton Pump Inhibitors in France (2009-2019): A Time-Series Analysis of Trends and Practice Guidelines Impact. J Pediatr 2022; 245:158-164.e4. [PMID: 35120983 DOI: 10.1016/j.jpeds.2022.01.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/28/2021] [Accepted: 01/25/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To describe the ambulatory proton pump inhibitor (PPI) prescription in French children, its trends, and the impact of French (2014) and international (2018) clinical guidelines. STUDY DESIGN We described PPI prescription rates based on national dispensation data in French children (IQVIA's Xponent database, 2009-2019). Using a segmented linear regression, we assessed the impact of clinical guidelines on PPI prescription rates. Analyses were performed for the overall pediatric population and by age subgroups (infants <2 years old, children 2-11 years old, adolescents 12-17 years old). RESULTS During the study period, 8 060 288 pediatric PPI prescriptions were filled, with a mean PPI prescription rate of 52.5 per 1000 inhabitants per year. Between 2009 and 2019, the PPI prescription rate increased by 41% in the overall pediatric population (+110% in infants). The PPI prescription rate showed seasonal patterns with peaks in winter. After the release of French guidelines, significant decreases in trends of prescription rates occurred overall (change in trend -0.28, 95% CI -0.34;-0.23) and across all age groups. In infants, this change in trend was not sufficient to reverse the PPI prescription rate that was still increasing over time. In children, the PPI prescription rate slightly decreased and in adolescents, it was stable. After the release of international guidelines, a significant decrease in trend occurred in adolescents only (change in trend -0.26, 95% CI -0.47; -0.04). CONCLUSIONS The pediatric PPI prescription rate in France was high, displayed a major increase over the last decade, mainly among infants, and was modestly affected by clinical guidelines.
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Affiliation(s)
- Shuai Yang
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Centre for Epidemiology and Statistics (CRESS), Université de Paris, Paris, France
| | - Nhung T H Trinh
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Centre for Epidemiology and Statistics (CRESS), Université de Paris, Paris, France; IQVIA, La Défense, France
| | - Martin Chalumeau
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Centre for Epidemiology and Statistics (CRESS), Université de Paris, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
| | - Florentia Kaguelidou
- Department of Pediatric Pharmacology and Pharmacogenetics, Robert-Debré Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; Inserm, Clinical Investigation Center, Paris, France
| | - Frank M Ruemmele
- Pediatric Gastroenterology Hepatology and Nutrition, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France; Institut Imagine, Inserm U 1163, Paris, France
| | | | | | - Jérémie F Cohen
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Centre for Epidemiology and Statistics (CRESS), Université de Paris, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Marion Taine
- Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Centre for Epidemiology and Statistics (CRESS), Université de Paris, Paris, France
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4
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Arnoux A, Bailhache M, Tetard C, Rebouissoux L, Clouzeau H, Lamireau T, Enaud R. Proton pump inhibitors are still overprescribed for hospitalized children. Arch Pediatr 2022; 29:258-262. [PMID: 35304031 DOI: 10.1016/j.arcped.2022.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/17/2021] [Accepted: 02/20/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The use of proton pump inhibitors has increased exponentially over the past 20 years. Several side effects have been reported and concerns exist about the consequences of long-term proton pump inhibitors on health, leading to limitation of their use. The present study analyzed prescriptions of proton pump inhibitors at inpatient units and assessed their compliance with current recommendations. METHODS This single-center, observational, retrospective study reviewed medical file of patients hospitalized at the pediatric medical departments of the Bordeaux University Hospital between April 1 and September 30, 2019. Patients younger than 18 years, hospitalized in the pediatric hospital units and treated with proton pump inhibitors were included. Prescriptions of proton pump inhibitors were compared with French and international guidelines. RESULTS Proton pump inhibitors were prescribed for 251 of 2237 children (11%), mainly for gastroesophageal reflux disease (47%) and prevention of peptic ulcer disease (32.7%). Proton pump inhibitor prescription complied to recommendations in 34.5% of cases, less often in children aged younger than 1 year (13.5%) than in older children. Compliance to recommendations was lower when proton pump inhibitors were indicated for the prevention of peptic disease (5%) than for gastroesophageal reflux disease (48%). CONCLUSIONS Proton pump inhibitors are frequently prescribed for hospitalized children, and indications comply with recommendations in only 35% of the cases. Efforts in spreading awareness of the recommendations on the use of proton pump inhibitors in children are mandatory among hospital pediatricians.
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Affiliation(s)
- A Arnoux
- Bordeaux University Hospital, Pediatric department, Pediatric Gastroenterology Unit, France
| | - M Bailhache
- Bordeaux University Hospital, Pediatric department, Pediatric Emergency Unit, France
| | - C Tetard
- Bordeaux University Hospital, Pediatric department, Pediatric Gastroenterology Unit, France
| | - L Rebouissoux
- Bordeaux University Hospital, Pediatric department, Pediatric Gastroenterology Unit, France
| | - H Clouzeau
- Bordeaux University Hospital, Pediatric department, Pediatric Gastroenterology Unit, France
| | - T Lamireau
- Bordeaux University Hospital, Pediatric department, Pediatric Gastroenterology Unit, France
| | - R Enaud
- Bordeaux University Hospital, Pediatric department, Pediatric Gastroenterology Unit, France.
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Quitadamo P, Zenzeri L, Mozzillo E, Giorgio V, Rocco A, Franzese A, Nardone G, Staiano A. Plasma dosage of ghrelin, IGF-1, GLP- 1 and leptin related to gastric emptying and esophageal pH-impedance in children with obesity. J Endocrinol Invest 2021; 44:1275-1281. [PMID: 32960416 DOI: 10.1007/s40618-020-01425-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 09/14/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE The main aim of the study was to assess the relationship between leptin, ghrelin, insulin-like growth factor 1 (IGF-1), and glucagon-like peptide 1 (GLP-1) blood levels and gastric motility in children with obesity compared to healthy children. Secondary aims were to assess the possible association between these hormones and obesity, reflux impedance parameters, reflux symptoms, other GI disorders, and quality-of-life scores within the same groups. METHODS Children with obesity plus GERD symptoms and 2 control groups of children with obesity without GERD and healthy lean children aged 4-17 years underwent an auxological evaluation, an assessment of gastro-intestinal symptoms and quality of life, hormonal dosages, and an evaluation of gastric emptying time (GET) through 13C-octanoic acid breath test. RESULTS No significant association was found between hormones and gastric motility. Leptin and ghrelin levels were significantly associated with obesity parameters. No significant differences were found between GET and hormones of the patients with obesity, either with or without GERD. CONCLUSION Although we found an association between auxological parameters and both leptin and ghrelin levels, this association did not imply an effect on the upper GI motility. Therefore, our hypothesis that alterations of these hormones in children with obesity could affect gastric emptying, triggering GERD, was not supported by our data.
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Affiliation(s)
- P Quitadamo
- Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Naples, Italy.
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Via Mario Fiore 6, 80129, Naples, Italy.
| | - L Zenzeri
- Department of Pediatrics, University of Perugia, Perugia, Italy
| | - E Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Naples, Italy
| | - V Giorgio
- UOC Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A Rocco
- Department of Gastroenterology, "Federico II" University of Naples, Naples, Italy
| | - A Franzese
- Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Naples, Italy
| | - G Nardone
- Department of Gastroenterology, "Federico II" University of Naples, Naples, Italy
| | - A Staiano
- Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Naples, Italy
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Levy EI, Salvatore S, Vandenplas Y, de Winter JP. Prescription of acid inhibitors in infants: an addiction hard to break. Eur J Pediatr 2020; 179:1957-1961. [PMID: 33150519 DOI: 10.1007/s00431-020-03855-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Elvira Ingrid Levy
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, 101, 1090, Brussels, Belgium
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Yvan Vandenplas
- KidZ Health Castle, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan, 101, 1090, Brussels, Belgium.
| | - J Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Hoofddorp/Haarlem, The Netherlands.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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7
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Bellaiche M, Ategbo S, Krumholz F, Ludwig T, Miqdady M, Abkari A, Vandenplas Y. A large-scale study to describe the prevalence, characteristics and management of functional gastrointestinal disorders in African infants. Acta Paediatr 2020; 109:2366-2373. [PMID: 32150302 PMCID: PMC7687079 DOI: 10.1111/apa.15248] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/03/2020] [Accepted: 03/05/2020] [Indexed: 12/31/2022]
Abstract
AIM To evaluate the pattern, impact on quality of life and management of common functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants below 1 year of age in Africa. METHODS Multicentre, cross-sectional, observational study in 10 African countries. At the first paediatric consultation of children with gastrointestinal symptoms, the perception of paediatricians on FGIDs (infant colic, constipation and regurgitation) and gas/bloating, impact on infant quality of life and parental anxiety and patient management practices were evaluated by standardised questionnaires. RESULTS Questionnaires were completed by 759 paediatricians for 10 812 infants. Overall, 49.9% of paediatricians reported ≥30% of first infant consultations each month for FGIDs or related symptoms. Infant colic was most commonly diagnosed (57.6% of infants), followed by gas/bloating (43.2%), regurgitation (39.7%) and constipation (31.4%). Overall, 53% presented >1 symptom. Mean scores for infant quality of life, sleep and parental anxiety were worse when children had multiple symptoms compared to children with a single symptom (P < .025). Prescription of medication was common (62.4%). There were no consistent differences between countries. CONCLUSION Functional gastrointestinal disorder occurrence in Africa was high with a gap between expert recommendation that emphasises parental reassurance and nutritional advice and daily practice, particularly prescription of medication.
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Affiliation(s)
- Marc Bellaiche
- Paediatrics Gastroenterology DepartmentRobert‐Debré HospitalParisFrance
| | - Simon Ategbo
- Paediatics DepartmentAngondjé HospitalLibrevilleGabon
| | | | | | - Mohamad Miqdady
- Pediatric Gastroenterology, Hepatology and Nutrition DivisionSheikh Khalifa Medical CityAbu DhabiUnited Arab Emirates
| | - Abdelhak Abkari
- Paediatrics Gastroenterology DepartmentIbn Rochd HospitalCasablancaMorocco
| | - Yvan Vandenplas
- KidZ Health CastleUZ BrusselVrije Universiteit BrusselBrusselsBelgium
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Vandenplas Y, Hauser B, Salvatore S. Functional Gastrointestinal Disorders in Infancy: Impact on the Health of the Infant and Family. Pediatr Gastroenterol Hepatol Nutr 2019; 22:207-216. [PMID: 31110953 PMCID: PMC6506429 DOI: 10.5223/pghn.2019.22.3.207] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 01/27/2019] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
Functional gastrointestinal disorders (FGIDs) such as infantile colic, constipation and colic occur in almost half of the infants. The aim of this paper is to provide a critical and updated review on the management of FGIDs and their impact on the health of the infant and family to health care physicians. Guidelines and expert recommendations were reviewed. FGIDs are a frequent cause of parental concern, impairment in quality of life of infants and relatives, and impose a financial burden to families, health care, and insurance. Therefore, primary management of the FGIDs should be focused on improving the infants' symptoms and quality of life of the family. If more than parental reassurance is needed, available evidence recommends nutritional advice as it is an effective strategy and most of the time devoid of adverse effects. The role of healthcare providers in reassuring parents and proposing the correct behavior and nutritional intervention by avoiding inappropriate use of medication, is essential in the management of FGIDs.
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Affiliation(s)
- Yvan Vandenplas
- KidZ Health Castle, UZ Brussel; Vrije Universiteit Brussel, Brussels, Belgium
| | - Bruno Hauser
- KidZ Health Castle, UZ Brussel; Vrije Universiteit Brussel, Brussels, Belgium
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A Multifaceted Intervention to Reduce Pediatric Acid-Suppressant Prescriptions for Gastroesophageal Reflux: What Have We Learned? J Pediatr Gastroenterol Nutr 2018; 67:605-609. [PMID: 29901547 DOI: 10.1097/mpg.0000000000002054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Acid-suppressant prescriptions for children have increased over past decades, despite guideline recommendations to prescribe prudently. Acid suppressants are often ineffective and may lead to side effects. We aimed to reduce inappropriate acid-suppressant prescriptions for gastroesophageal reflux in a tertiary care setting through active implementation of national guideline recommendations and to evaluate intervention effect. METHODS Implementation consisted of 2 steps. First, all pediatric clinicians in an academic hospital received information on appropriate acid-suppressant prescribing, a link to an online national guideline application and summary card with important evidence-based recommendations-Wise Choices. Hereafter, clinicians prescribing acid suppressants were contacted to provide feedback on indications and to assess their knowledge of the guideline and Wise Choices. The pharmacy database supplied prescription data before, during, and after this intervention. RESULTS During the study period prescriptions ranged from 115 to 201/month. Ten months postintervention, a nonsignificant decrease of 4 prescriptions/month was measured (95% confidence interval -49-41). Of the 78 prescribers 76 were successfully contacted: 63% were familiar with the guideline and 45% with Wise Choices. Thirty percent of prescriptions were for gastroesophageal reflux symptoms. CONCLUSION This multifaceted implementation strategy did not lead to a significant difference in acid-suppressant prescriptions by tertiary care clinicians of whom the majority was familiar with the gastroesophageal reflux disease guideline. Future studies should clarify, which implementation strategies are most effective in reducing inappropriate prescribing of acid suppressants for children. Uniform registration of prescriptions and indications in a national database will enable monitoring of the intervention effect.
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Salvatore S, Abkari A, Cai W, Catto‐Smith A, Cruchet S, Gottrand F, Hegar B, Lifschitz C, Ludwig T, Shah N, Staiano A, Szajewska H, Treepongkaruna S, Vandenplas Y. Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants. Acta Paediatr 2018; 107:1512-1520. [PMID: 29710375 PMCID: PMC6120453 DOI: 10.1111/apa.14378] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/21/2018] [Accepted: 04/23/2018] [Indexed: 12/31/2022]
Abstract
AIM Regurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders (FGIDs) during infancy. Our aim was to carry out a concise review of the literature, evaluate the impact of these common FGIDs on infants and their families, and provide an overview of national and international guidelines and peer-reviewed expert recommendations on their management. METHODS National and international guidelines and peer-reviewed expert recommendations on the management of regurgitation, infantile colic and functional constipation were examined and summarised. RESULTS Regurgitation, infantile colic and functional constipation cause frequent parental concerns, lead to heavy personal and economic costs for families and impose a financial burden on public healthcare systems. Guidelines emphasise that the first-line management of these common FGIDs should focus on parental education, reassurance and nutritional advice. Nutritional advice should stress the benefits of continuing breastfeeding, while special infant formulas may be considered for non-breastfed infants with common FGIDs. Drug treatment is seldom required, with the exception of functional constipation. CONCLUSION By providing complete and updated parental education, reassurance and nutritional advice, healthcare professionals can optimise the management of FGIDs and related symptoms and reduce the inappropriate use of medication or dietary interventions.
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Affiliation(s)
| | - Abdelhak Abkari
- Faculty of MedicineUnit of Pediatric GastroenterologyUniversity Hospital Ibn RochdUniversity Hassan2CasablancaMorocco
| | - Wei Cai
- Xin Hua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Anthony Catto‐Smith
- Lady Cilento Children's HospitalQueensland University of TechnologyBrisbaneAustralia
| | - Sylvia Cruchet
- Institute of Nutrition and Food TechnologyUniversity of Chile (INTA)SantiagoChile
| | - Frederic Gottrand
- Department of PediatricsJeanne de Flandre Children's HospitalCHU LilleUniversity of LilleLilleFrance
| | - Badriul Hegar
- Division of GastrohepatologyDepartment of Child HealthFaculty of MedicineUniversitas IndonesiaJakartaIndonesia
| | | | | | - Neil Shah
- Great Ormond Street HospitalLondonUK
| | - Annamaria Staiano
- Department of Translational Medical ScienceSection of PediatricsUniversity of Naples Federico IINaplesItaly
| | - Hania Szajewska
- Department of PaediatricsThe Medical University of WarsawWarsawPoland
| | - Suporn Treepongkaruna
- Department of PediatricsFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Yvan Vandenplas
- KidZ Health CastleUZ BrusselVrije Universiteit BrusselBrusselsBelgium
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11
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Combined multichannel intraluminal impedance and pH monitoring is helpful in managing children with suspected gastro-oesophageal reflux disease. Dig Liver Dis 2018; 50:910-915. [PMID: 29724467 DOI: 10.1016/j.dld.2018.03.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/26/2018] [Accepted: 03/27/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux is very common in the paediatric age group. There is no single and reliable test to distinguish between physiologic and pathological gastro-oesophageal reflux, and this lack of clear distinction between disease and normal can have a negative impact on the management of children. AIMS To evaluate the usefulness of 24-h oesophageal pH-impedance study in infants and children with suspected gastro-oesophageal reflux disease. METHODS Patients were classified by age groups (A-C) and reflux-related symptoms (typical and atypical). All underwent pH-impedance study. If the latter suggested an abnormal reflux, patients received therapy in accordance with NASPGHAN/ESPGHAN recommendations, while those with normal study had an additional diagnostic work-up. The efficacy of therapy was evaluated with a specific standardized questionnaire for different ages. RESULTS The study was abnormal in 203/428 patients (47%) while normal in 225/428 (53%). Of those with abnormal study, 109 exhibited typical symptoms (54%), and 94 atypical (46%). The great majority of the patients with abnormal study were responsive to medical anti-reflux therapy. CONCLUSIONS We confirm the utility of prolonged oesophageal pH-impedance study in detecting gastro-oesophageal reflux disease in children and in guiding therapy. Performing oesophageal pH-impedance monitoring in children with suspected gastro-oesophageal reflux disease is helpful to establish the diagnosis and avoid unnecessary therapy.
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12
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Survey on the Adherence to the 2009 NASPGHAN-ESPGHAN Gastroesophageal Reflux Guidelines by Brazilian Paediatricians. J Pediatr Gastroenterol Nutr 2018; 67:e1-e5. [PMID: 29394212 DOI: 10.1097/mpg.0000000000001902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the management of gastroesophageal reflux in children among Brazilian pediatricians and adherence to the 2009 North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN), and European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Guideline in Brazil. METHODS An observational cross-sectional study was conducted, applying a standard questionnaire with 12 questions about gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) management in infants, children, and adolescents to the pediatricians during the 37th Brazilian Pediatrics Congress in October, 2015. Adherence to the 2009 NASPGHAN-ESPGHAN Guideline was verified through analyses of interviewees' answers. Pediatricians' demographic and professional characteristics were screened. RESULTS A total of 390 Brazilian pediatricians answered the questionnaire. None showed complete adherence to Guideline recommendations. GERD diagnosis by history alone was reported by 67%, irrespective of the child's age. The mean score for diagnostic adherence to the guidelines was 0.94 ± 0.86 (range 0-4). Working in public health services (P = 0.026) was the only variable retained as a significant predictor of poor adherence for GER/GERD diagnosis after multivariate logistic regression analysis. No significant statistical differences were found between Brazilian regions on total score (P = 0.774). Proton pump inhibitors were prescribed by 28.4% of the pediatricians independent of child's age, and 59% use proton pump inhibitors to treat babies with unexplained crying and/or distressed behavior. CONCLUSIONS 2009 NASPGHAN-ESPGHAN Guideline recommendations had poor adherence by Brazilian pediatricians. Studies evaluating the reasons for the poor adherence to NASPGHAN/ESPGHAN guidelines are urgently needed.
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14
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Manasfi H, Hanna‐Wakim R, Akel I, Yazbeck N. Questionnaire-based survey in a developing country showing noncompliance with paediatric gastro-oesophageal reflux practice guidelines. Acta Paediatr 2017; 106:316-321. [PMID: 27792252 DOI: 10.1111/apa.13648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/10/2016] [Accepted: 10/25/2016] [Indexed: 11/27/2022]
Abstract
AIM This 2015 study investigated whether Lebanese paediatricians diagnosed and managed gastro-oesophageal reflux disease (GERD) in infants and children in accordance with the 2009 guidelines from the North American and European Societies for Paediatric Gastroenterology, Hepatology and Nutrition. METHODS Paediatricians members of the Lebanese Order of Physicians with updated email addresses were invited to complete a web-based survey between September and November 2015, to assess their knowledge and management of GERD. RESULTS Responses were received from 114 of the 543 paediatricians, and 96 were analysed. Only two respondents complied fully with the international guidelines. The majority diagnosed GERD in infants based solely on their medical history and examination. Moreover, nearly two-thirds of the respondents would start an empiric trial with acid suppression. Around half of the respondents considered proton pump inhibitors to be the mainstay of GERD treatment. CONCLUSION This was the first Lebanese study that surveyed the management of paediatric GERD. Only 2.1% of the paediatricians followed the guidelines on the evidence-based management of GERD. This highlights the need for studies to assess barriers to guideline implementation and the development of new guidelines accounting for regional factors, mainly the cost of investigations and prevalence of medical insurance.
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Affiliation(s)
- Hayat Manasfi
- Department of Paediatrics and Adolescent Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Rima Hanna‐Wakim
- Department of Paediatrics and Adolescent Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Imad Akel
- Department of Paediatrics and Adolescent Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Nadine Yazbeck
- Department of Paediatrics and Adolescent Medicine American University of Beirut Medical Center Beirut Lebanon
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Glanville J, Ludwig T, Lifschitz C, Mahon J, Miqdady M, Saps M, Hock Quak S, Lenoir-Wijnkoop I, Edwards M, Wood H, Szajewska H. Costs associated with functional gastrointestinal disorders and related signs and symptoms in infants: a systematic review protocol. BMJ Open 2016; 6:e011475. [PMID: 27558903 PMCID: PMC5013437 DOI: 10.1136/bmjopen-2016-011475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 07/08/2016] [Accepted: 07/29/2016] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Functional gastrointestinal disorders (FGIDs) and FGID-related signs and symptoms have a fundamental impact on the psychosocial, physical and mental well-being of infants and their parents alike. Recent reviews and studies have indicated that FGIDs and related signs and symptoms may also have a substantial impact on the budgets of third-party payers and/or parents. The objective of this systematic review is to investigate these costs. METHODS AND ANALYSIS The population of interest is healthy term infants (under 12 months of age) with colic, regurgitation and/or functional constipation. Outcomes of interest will include the frequency and volume of reported treatments, the cost to third-party payers and/or parents for prescribed or over the counter treatments, visits to health professionals and changes in infant formula purchases, and the loss of income through time taken off work and out of pocket costs. Relevant studies will be identified by searching databases from 2005 onwards (including MEDLINE, EMBASE, PsycINFO, NEXIS, DARE, Health Technology Assessment database, National Health Service Economic Evaluation Database and others), conferences from the previous 3 years and scanning reference lists of eligible studies. Study selection, data extraction and quality assessment will be conducted by two independent reviewers and disagreements resolved in discussion with a third reviewer. Quality assessment will involve study design-specific checklists. Relevant studies will be summarised narratively and presented in tables. An overview of treatments and costs will be provided, with any geographical or other differences highlighted. An assessment of how the totals for cost differ across countries and elements that contribute to the differences will be generated. ETHICS AND DISSEMINATION This is a systematic review of published studies that will be submitted for publication to a peer-reviewed journal. Ethical committee approval is not required. TRIAL REGISTRATION NUMBER CRD42016033119.
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Affiliation(s)
- Julie Glanville
- York Health Economics Consortium, University of York, York, UK
| | | | | | - James Mahon
- York Health Economics Consortium, University of York, York, UK
| | - Mohamad Miqdady
- Pediatric Gastroentrology, Hepatology and Nutrition Division, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Miguel Saps
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | | | - Mary Edwards
- York Health Economics Consortium, University of York, York, UK
| | - Hannah Wood
- York Health Economics Consortium, University of York, York, UK
| | - Hania Szajewska
- Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
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