1
|
Amil-Dias J, Oliva S, Papadopoulou A, Thomson M, Gutiérrez-Junquera C, Kalach N, Orel R, Auth M, Nijenhuis-Hendriks D, Strisciuglio C, Bauraind O, Chong S, Ortega GD, Férnandez SF, Furman M, Garcia-Puig R, Gottrand F, Homan M, Huysentruyt K, Kostovski A, Otte S, Rea F, Roma E, Romano C, Tzivinikos C, Urbonas V, Velde SV, Zangen T, Zevit N. Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2024. [PMID: 38923067 DOI: 10.1002/jpn3.12188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and histologically by predominantly eosinophilic infiltration of the squamous epithelium. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published a guideline in 2014; however, the rapid evolution of knowledge about pathophysiology, diagnostic criteria, and therapeutic options have made an update necessary. METHODS A consensus group of pediatric gastroenterologists from the ESPGHAN Working Group on Eosinophilic Gastrointestinal Diseases (ESPGHAN EGID WG) reviewed the recent literature and proposed statements and recommendations on 28 relevant questions about EoE. A comprehensive electronic literature search was performed in MEDLINE, EMBASE, and Cochrane databases from 2014 to 2022. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of evidence and formulate recommendations. RESULTS A total of 52 statements based on the available evidence and 44 consensus-based recommendations are available. A revision of the diagnostic protocol, options for initial drug treatment, and the new concept of simplified empiric elimination diets are now available. Biologics are becoming a part of the potential armamentarium for refractory EoE, and systemic steroids may be considered as the initial treatment for esophageal strictures before esophageal dilation. The importance and assessment of quality of life and a planned transition to adult medical care are new areas addressed in this guideline. CONCLUSION Research in recent years has led to a better understanding of childhood EoE. This guideline incorporates the new findings and provides a practical guide for clinicians treating children diagnosed with EoE.
Collapse
Affiliation(s)
- Jorge Amil-Dias
- Pediatric Gastroenterology, Hospital Lusíadas, Porto, Portugal
| | - Salvatore Oliva
- Maternal and Child Health Department, University Hospital - Umberto I, Sapienza - University of Rome, Rome, Italy
| | - Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, Children's hospital Agia Sofia, University of Athens, Athens, Greece
| | - Mike Thomson
- Centre for Paediatric Gastroenterology, International Academy for Paediatric Endoscopy Training, Sheffield Children's Hospital, UK
| | - Carolina Gutiérrez-Junquera
- Pediatric Gastroenterology Unit, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Spain
| | - Nicolas Kalach
- Department of Pediatrics, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University, Lille, France
| | - Rok Orel
- Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marcus Auth
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialized Surgery of the University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Sonny Chong
- Epsom and St Helier University Hospitals NHS Trust, UK
| | - Gloria Dominguez Ortega
- Pediatric Gastroenterology and Nutrition Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sonia Férnandez Férnandez
- Pediatric Gastroenterology Unit, Department of Pediatrics, Severo Ochoa University Hospital, Madrid, Spain
| | - Mark Furman
- Royal Free London NHS Foundation Trust, London, UK
| | - Roger Garcia-Puig
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Pediatrics Department, Hospital Universitari MútuaTerrassa, Universitat de Barcelona, Barcelona, Spain
| | | | - Matjaz Homan
- Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Koen Huysentruyt
- Kindergastro-enterologie, hepatologie en nutritie, Brussels Centre for Intestinal Rehabilitation in Children (BCIRC), Belgium
| | - Aco Kostovski
- University Children's Hospital Skopje, Faculty of Medicine, University Ss Cyril and Methodius, Skopje, Republic of North Macedonia
| | - Sebastian Otte
- Childrens' Hospital, Helios Mariahilf Hospital, Hamburg, Germany
| | - Francesca Rea
- Endoscopy and Surgey Unit, Bambino Gesu Children's Hospital, Rome, Italy
| | - Eleftheria Roma
- First Department of Pediatrics, University of Athens and Pediatric Gastroenterology Unit Mitera Children's Hospital, Athens, Greece
| | - Claudio Romano
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Christos Tzivinikos
- Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, UAE
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Vaidotas Urbonas
- Vilnius University Medical Faculty Clinic of Children's Diseases, Vilnius, Lithuania
| | | | - Tsili Zangen
- Pediatric Gastroenterology Unit, Wolfson Medical Center, Holon, Israel
| | - Noam Zevit
- Eosinophilic Gastrointestinal Disease Clinic, Institute of Gastroenterology, Hepatology, and Nutrition, Schneider Children's Medical Center of Israel, Israel
| |
Collapse
|
2
|
Størdal K, Ma A, Beck CE. Reducing the use of proton pump inhibitors in infants with reflux symptoms. BMJ 2024; 385:e074588. [PMID: 38816024 DOI: 10.1136/bmj-2022-074588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Affiliation(s)
- Ketil Størdal
- Department of Paediatric Research, Faculty of Medicine, University of Oslo, Pb 4956 Nydalen, NO-0424 Oslo, Norway
- Department of Paediatrics, Oslo University Hospital, Oslo
| | | | - Carolyn E Beck
- Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
- University of Toronto, Toronto
| |
Collapse
|
3
|
Carabelli G, Binotto I, Armano C, Bertù L, Luini C, Nosetti L, Agosti M, Salvatore S. Study on Nocturnal Infant Crying Evaluation (NICE) and Reflux Disease (RED). CHILDREN (BASEL, SWITZERLAND) 2024; 11:450. [PMID: 38671666 PMCID: PMC11048841 DOI: 10.3390/children11040450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/31/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Nocturnal infant crying is often empirically treated with acid suppressants. The aim of this study was to evaluate the prevalence and characteristics of gastroesophageal reflux (GER) in infants with unexplained persistent crying. METHODS We enrolled all infants (0-12 months) referred for suspected GER disease who underwent esophageal impedance-pH monitoring (MII-pH) for unexplained persistent crying not improved by parental reassurance, dietary modification or alginate. Gastrointestinal malformation/surgery, neurological impairment and infections were exclusion criteria. Demographic and anthropometric parameters, GER symptoms and questionnaires (I-GERQ-R) and MII-pH data were recorded and analyzed. Normal MII-pH was defined when acid exposure was <3%, symptom index was <50% and symptom association probability was <95%. Acid exposure >5% and >10% was also considered. Statistical analysis was performed using Chi-Square and univariate and multivariable regression analysis. RESULTS We included 50 infants (median age 3.5 months) who fulfilled the study criteria: 30 (60%) had normal MII-pH. I-GERQ-R score was abnormal in 33 (66%) infants, and 21/33 (64%) had normal MII-pH (p = 0.47). In the 26 (52%) infants with nocturnal crying, MII-pH was normal in 16 (54%) (p = 0.82). Associated regurgitation (>3 or >10 episodes/die) did not predict abnormal MII-pH (p = 0.74, p = 0.82, respectively). Univariate and multivariable regression analysis did not identify any clinical variable significantly associated with abnormal MII-pH. CONCLUSIONS Infants with persistent unexplained and nocturnal crying should not be empirically treated with acid inhibitors.
Collapse
Affiliation(s)
- Greta Carabelli
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Ivan Binotto
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Chiara Armano
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Lorenza Bertù
- Research Center Tromboembolic Diseases, University of Insubria, 21100 Varese, Italy;
| | - Chiara Luini
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Luana Nosetti
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Massimo Agosti
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| | - Silvia Salvatore
- Pediatric Department, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (G.C.); (I.B.); (C.A.); (C.L.); (L.N.); (M.A.)
| |
Collapse
|
4
|
Bacarreza-Nogales DV, Ruiz-Castillo MA, Cázares-Méndez JM, Chávez-Barrera JA, Fernández-Ortiz SJ, Guillén-Chávez A, Hernández-Vez G, López-Ugalde MV, Montijo-Barrios E, Toro-Monjaraz E, Trauernicht-Mendieta S, Garza J, Rodríguez L. The consensus of the Asociación Mexicana de Gastroenterología on the diagnosis and treatment of gastroesophageal reflux and gastroesophageal reflux disease in infants. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2024; 89:265-279. [PMID: 38789310 DOI: 10.1016/j.rgmxen.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/28/2024] [Indexed: 05/26/2024]
Abstract
Gastroesophageal reflux (GER) is a frequent normal phenomenon in children of any age. It is more common in infants, in whom the majority of episodes are short-lived and cause no other symptoms or complications, differentiating it from gastroesophageal reflux disease (GERD). The diagnosis and management of GER and GERD continue to be a challenge for the physician. Therefore, the aim of the Asociación Mexicana de Gastroenterología was to adapt international documents to facilitate their adoption by primary care physicians, with the goal of standardizing quality of care and reducing the number of diagnostic tests performed and inappropriate medication use. The ADAPTE methodology was followed, and the recommendations were approved utilizing the Delphi strategy. The executive committee carried out the review of the guidelines, position papers, and international reviews that met the a priori quality criteria and possible applicability in a local context. The recommendations were taken from those sources and adapted, after which they were approved by the working group. The consensus consists of 25 statements and their supporting information on the diagnosis and treatment of GER and GERD in infants. The adapted document is the first systematic effort to provide an adequate consensus for use in Mexico, proposing a practical approach to and management of GER and GERD for healthcare providers.
Collapse
Affiliation(s)
| | - M A Ruiz-Castillo
- Servicio de Gastroenterología Pediátrica, Hospital del niño DIF, Pachuca, Hidalgo, Mexico.
| | | | - J A Chávez-Barrera
- Departamento de Gastroenterología, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - S J Fernández-Ortiz
- Instituto de Pediatría Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico
| | - A Guillén-Chávez
- Servicio de Neonatología, Hospital de Ginecoobstetricia No 7, Instituto Mexicano del Seguro Social, Tijuana, Baja California, Mexico
| | | | - M V López-Ugalde
- Centro Médico San Cristobal, San Cristobal de Las Casas, Chiapas, Mexico
| | - E Montijo-Barrios
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - E Toro-Monjaraz
- Departamento de Gastroenterología y Nutrición, Instituto Nacional de Pediatría, Mexico City, Mexico
| | - S Trauernicht-Mendieta
- Departamento de Gastroenterología y Nutrición, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
| | - J Garza
- GI Care for Kids Children's Healthcare of Atlanta, Georgia, United States
| | - L Rodríguez
- Centro de Neuro-gastroenterología y Motilidad, Universidad de Yale, New Haven, Connecticut, United States
| |
Collapse
|
5
|
Wilschanski M, Munck A, Carrion E, Cipolli M, Collins S, Colombo C, Declercq D, Hatziagorou E, Hulst J, Kalnins D, Katsagoni CN, Mainz JG, Ribes-Koninckx C, Smith C, Smith T, Van Biervliet S, Chourdakis M. ESPEN-ESPGHAN-ECFS guideline on nutrition care for cystic fibrosis. Clin Nutr 2024; 43:413-445. [PMID: 38169175 DOI: 10.1016/j.clnu.2023.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Nutritional status is paramount in Cystic Fibrosis (CF) and is directly correlated with morbidity and mortality. The first ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with CF were published in 2016. An update to these guidelines is presented. METHODS The study was developed by an international multidisciplinary working group in accordance with officially accepted standards. Literature since 2016 was reviewed, PICO questions were discussed and the GRADE system was utilized. Statements were discussed and submitted for on-line voting by the Working Group and by all ESPEN members. RESULTS The Working Group updated the nutritional guidelines including assessment and management at all ages. Supplementation of vitamins and pancreatic enzymes remains largely the same. There are expanded chapters on pregnancy, CF-related liver disease, and CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics. There are new chapters on nutrition with highly effective modulator therapies and nutrition after organ transplantation.
Collapse
Affiliation(s)
- Michael Wilschanski
- Pediatric Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
| | - Anne Munck
- Cystic Fibrosis Centre, Hopital Necker-Enfants Malades, AP-HP, Paris, France
| | - Estefania Carrion
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada
| | - Marco Cipolli
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sarah Collins
- CF Therapies Team, Royal Brompton & Harefield Hospital, London, UK
| | - Carla Colombo
- University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Dimitri Declercq
- Cystic Fibrosis Reference Centre, Ghent University Hospital and Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Elpis Hatziagorou
- Cystic Fibrosis Unit, 3rd Pediatric Dept, Hippokration Hospital, Aristotle University of Thessaloniki, Greece
| | - Jessie Hulst
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada; Department of Pediatrics and Department of Nutritional Sciences, The University of Toronto, Toronto, Canada
| | - Daina Kalnins
- Department of Clinical Dietetics, The Hospital for Sick Children, Toronto, Canada
| | - Christina N Katsagoni
- Department of Clinical Nutrition, Agia Sofia Children's Hospital, Athens, Greece; EFAD, European Specialist Dietetic Networks (ESDN) for Gastroenterology, Denmark
| | - Jochen G Mainz
- Brandenburg Medical School, University Hospital. Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - Carmen Ribes-Koninckx
- Pediatric Gastroenterology and Paediatric Cystic Fibrosis Unit. La Fe Hospital & La Fe Research Institute, Valencia, Spain
| | - Chris Smith
- Department of Dietetics, Royal Alexandra Children's Hospital, Brighton, UK
| | - Thomas Smith
- Independent Patient Consultant Working at Above-disease Level, UK
| | | | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
6
|
Räisänen L, Viljakainen H, Kolho KL. Exposure to proton pump inhibitors is associated with the development of pediatric autoimmune diseases. Front Pediatr 2023; 11:1157547. [PMID: 37051434 PMCID: PMC10083351 DOI: 10.3389/fped.2023.1157547] [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: 02/02/2023] [Accepted: 03/08/2023] [Indexed: 04/14/2023] Open
Abstract
Proton pump inhibitors (PPIs) have been associated with decreased gut microbiota diversity. Disrupted gut microbiota composition has been reported in several autoimmune diseases (ADs), such as type 1 diabetes mellitus (DM), autoimmune thyroiditis (AIT), juvenile idiopathic arthritis (JIA), and inflammatory bowel diseases (IBD). We investigated whether PPIs are associated with the development of ADs in children and concluded that PPI exposures could be related to the onset of ADs, especially IBD and potentially AIT as well.
Collapse
Affiliation(s)
- Laura Räisänen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Correspondence: Laura Räisänen Kaija-Leena Kolho
| | - Heli Viljakainen
- Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland
- Children’s Hospital, University of Helsinki and HUS, Helsinki, Finland
| | - Kaija-Leena Kolho
- Children’s Hospital, University of Helsinki and HUS, Helsinki, Finland
- Faculty of Medicine and Medical Technology, Tampere University, Tampere, Finland
- Correspondence: Laura Räisänen Kaija-Leena Kolho
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Barbieur J, Levy EI, Vandenplas Y. Efficacy and safety of medical and nutritional management of gastroesophageal reflux in formula-fed infants: a narrative review. Curr Opin Pediatr 2022; 34:503-509. [PMID: 35855545 DOI: 10.1097/mop.0000000000001147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF 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). RECENT FINDINGS 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. SUMMARY 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.
Collapse
Affiliation(s)
- Jana Barbieur
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle
| | - Elvira Ingrid Levy
- Vrije Universiteit Brussel, UZ Brussel, KidZ Health Castle
- Department of Pediatrics, C.H.U. Saint-Pieter, Free University of Brussels, Brussels, Belgium
| | | |
Collapse
|
9
|
Romano C, Scarpignato C. Pharmacologic treatment of GERD in adolescents: Is esophageal mucosal protection an option? Therap Adv Gastroenterol 2022; 15:17562848221115319. [PMID: 36004307 PMCID: PMC9393348 DOI: 10.1177/17562848221115319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is still a challenging and difficult to treat condition in children. Although acid suppression represents the mainstay of treatment in adolescents, it is not devoid of adverse events, especially in the long-term. OBJECTIVES In this investigation we explored a new therapeutic avenue in GERD, that is esophageal mucosal protection. DESIGN To this end, we performed an investigator-initiated, retrospective study to evaluate the efficacy and safety of a short-term treatment with Esoxx™ medical device in 25 adolescents with GERD-related symptoms. This mucoadhesive formulation contains two natural mucopolysaccharides (sodium hyaluronate and chondroitin sulphate) and adheres to the esophageal mucosa, exerting a protective effect against refluxed gastric contents and allowing mucosal healing. METHODS Heartburn, epigastric burning and post-prandial regurgitation were scored with a pain VAS scale and re-evaluated after 3-week treatment with Esoxx (one stick post-prandially, three times daily). RESULTS All patients completed the treatment without adverse effects and with good tolerability and compliance. All the three major symptoms significantly (p<0.001) improved after treatment. No patient required additional investigation (i.e. upper Gastrointestinal endoscopy) or medication (i.e. antisecretory drugs). CONCLUSION The results of this pilot study suggest that esophageal mucosal protection is a promising therapeutic avenue for GERD also in children. Provided, these data be confirmed by a large, randomized clinical trial, this medical device can enter our therapeutic armamentarium against this challenging disease.
Collapse
Affiliation(s)
- Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis
Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”,
University of Messina, Messina, Italy
| | | |
Collapse
|
10
|
van Lennep M, Gottrand F, Faure C, Omari TI, Benninga MA, van Wijk MP, Krishnan U. Management of Gastroesophageal Reflux Disease in Esophageal Atresia Patients: A Cross-Sectional Survey amongst International Clinicians. J Pediatr Gastroenterol Nutr 2022; 75:145-150. [PMID: 35675703 PMCID: PMC9278714 DOI: 10.1097/mpg.0000000000003483] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/13/2022] [Indexed: 12/10/2022]
Abstract
OBJECTIVES After surgical repair, up to 70% of esophageal atresia (EA) patients suffer from gastroesophageal reflux disease (GERD). The ESPGHAN/NASPGHAN guidelines on management of gastrointestinal complications in EA patients were published in 2016. Yet, the implementation of recommendations on GERD management remains poor.We aimed to assess GERD management in EA patients in more detail, to identify management inconsistencies, gaps in current knowledge, and future directions for research. METHODS A digital questionnaire on GERD management in EA patients was sent to all members of the ESPGHAN EA working group and members of the International network of esophageal atresia (INoEA). RESULTS Forty responses were received. Thirty-five (87.5%) clinicians routinely prescribed acid suppressive therapy for 1-24 (median 12) months. A fundoplication was considered by 90.0% of clinicians in case of refractory GERD with persistent symptoms despite maximal acid suppressive therapy and in 92.5% of clinicians in case of GERD with presence of esophagitis on EGD. Half of clinicians referred patients with recurrent strictures or dependence on transpyloric feeds. Up to 25.0% of clinicians also referred all long-gap EA patients for fundoplication, those with long-term need of acid suppressants, recurrent chest infections and feedings difficulties. CONCLUSIONS Respondents' opinions on the optimal duration for routine acid suppressive therapy and indications for fundoplication in EA patients varied widely. To improve evidence-based care for EA patients, future prospective multicenter outcome studies should compare different diagnostic and treatment regimes for GERD in patients with EA. Complications of therapy should be one of the main outcome measures in such trials.
Collapse
Affiliation(s)
- Marinde van Lennep
- From the Amsterdam UMC location University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Frederic Gottrand
- CHU Lille, University Lille, National Reference Center for Congenital Malformation of the Esophagus, Department of Pediatric Gastroenterology Hepatology and Nutrition, Lille, France
| | - Christophe Faure
- the Division of Pediatric Gastroenterology, Sainte-Justine Hospital, Montréal, Québec, Canada
| | - Taher I Omari
- the College of Medicine & Public Health, Flinders University, Adelaide, SA, Australia
| | - Marc A Benninga
- From the Amsterdam UMC location University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
| | - Michiel P van Wijk
- From the Amsterdam UMC location University of Amsterdam, Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- the Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Pediatric Gastroenterology, Emma Children's Hospital, Boelelaan 1117, AmsterdamThe Netherlands
| | - Usha Krishnan
- the Department of Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, NSW, Australia
- the Discipline of Paediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
11
|
Lyamouri M, Mårild K, Gaardskaer Nielsen R, Størdal K. Proton pump inhibitors for infants in three Scandinavian countries increased from 2007-2020 despite international recommendations. Acta Paediatr 2022; 111:2222-2228. [PMID: 35860963 DOI: 10.1111/apa.16491] [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: 05/11/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/28/2022]
Abstract
AIM There is weak evidence that proton pump inhibitors (PPIs) alleviate non-specific complaints often attributed to gastroesophageal reflux in infancy and international guidelines do not recommend their use. We studied PPIs dispensed for infants in three Nordic countries. METHODS This was an observational population-based study of infants living in Norway, Sweden and Denmark in 2007-2020. We used nationwide pharmaceutical registers to study dispensed PPIs. The data provided a total of 3.3 million observed years on about 240,000 annual births. RESULTS The overall use of PPIs in infancy showed a marked increase in all three countries from 2007-2020. In 2020, PPI dispensing was 46.4, 23.4 and 18.9 per 1000 per year in infants aged 0-11 months in Denmark, Norway and Sweden. These were increases of 357%, 585% and 556% respectively. Although the rate was highest in Denmark, it had decreased by 42% in the last three years of the study. CONCLUSION Despite international recommendations against routine PPI prescribing in infancy, dispensed PPIs increased more than four-fold on average in three Nordic countries from 2007-2020. The reason for this notable increase could not be established from the data, but the large variations over time, and between the countries, probably indicated unwarranted use.
Collapse
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
| |
Collapse
|
12
|
Kołodziej M, Gieruszczak‐Białek D, Pieścik‐Lech M, Skórka A, Vandenplas Y, Szajewska H. Overuse continues despite no new evidence on the efficacy of proton pump inhibitors for crying and irritability in infants. Acta Paediatr 2022; 111:682-683. [PMID: 34837407 DOI: 10.1111/apa.16201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Maciej Kołodziej
- Department of Paediatrics The Medical University of Warsaw Warsaw Poland
| | | | | | - Agata Skórka
- Department of Paediatrics The Medical University of Warsaw Warsaw Poland
| | - Yvan Vandenplas
- Vrije Universiteit BrusselUZ BrusselKidZ Health Castle Brussels Belgium
| | - Hania Szajewska
- Department of Paediatrics The Medical University of Warsaw Warsaw Poland
| |
Collapse
|
13
|
Madeleine A, Audrey N, Rony S, David S, Frédéric G. Long term digestive outcome of œsophageal atresia. Best Pract Res Clin Gastroenterol 2021; 56-57:101771. [PMID: 35331402 DOI: 10.1016/j.bpg.2021.101771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
Œsophageal atresia is a rare neonatal malformation consisting in an interruption of the continuity of the œsophagus, with or without a tracheo-œsophageal fistula. Although mortality rate is now low and most cases can benefit from successful surgical repair soon after birth, morbidity -specially digestive and nutritional-remains high. Many of the adults born with œsophageal atresia will suffer from dysphagia, gastro-œsophageal reflux and/or œsophageal dysmotility, leading to nutritional consequences and quality of life impairment. Barrett's œsophagus, potential risk of œsophageal cancer as well as risk of anastomotic stenosis and eosinophilic œsophagitis justify transition to adulthood and a lifelong prolonged follow-up.
Collapse
Affiliation(s)
- Aumar Madeleine
- Univ. Lille, Reference Centre for rare œsophageal diseases, CHU Lille, U 1286 INFINITE, F59000, Lille, France.
| | - Nicolas Audrey
- Univ. Lille, Reference Centre for rare œsophageal diseases, CHU Lille, U 1286 INFINITE, F59000, Lille, France.
| | - Sfeir Rony
- Univ. Lille, Reference Centre for rare œsophageal diseases, CHU Lille, U 1286 INFINITE, F59000, Lille, France.
| | - Seguy David
- Univ. Lille, Reference Centre for rare œsophageal diseases, CHU Lille, U 1286 INFINITE, F59000, Lille, France.
| | - Gottrand Frédéric
- Univ. Lille, Reference Centre for rare œsophageal diseases, CHU Lille, U 1286 INFINITE, F59000, Lille, France.
| |
Collapse
|