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Leung AK, Hon KL. Gastroesophageal reflux in children: an updated review. Drugs Context 2019; 8:212591. [PMID: 31258618 PMCID: PMC6586172 DOI: 10.7573/dic.212591] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/17/2019] [Accepted: 05/21/2019] [Indexed: 12/14/2022] Open
Abstract
Background Gastroesophageal reflux is a common disorder in pediatrics. Clinicians should be familiar with the proper evaluation and management of this condition. Objective To provide an update on the current understanding, evaluation, and management of gastroesophageal reflux in children. Methods A PubMed search was performed with Clinical Queries using the key term ‘gastroesophageal reflux’. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature and the pediatric age group. Results Regurgitation is the most frequent symptom of gastroesophageal reflux and is present in nearly all cases. Gastroesophageal reflux occurs normally in infants, is often physiological, peaks at 4 months of age, and tends to resolve with time. Gastroesophageal reflux disease occurs when gastric contents reflux into the esophagus or oropharynx and produce troublesome symptom(s) and/or complication(s). A thorough clinical history and a thorough physical examination are usually adequate for diagnosis. When the diagnosis is ambiguous, diagnostic studies may be warranted. A combined esophageal pH monitoring and multichannel intraluminal esophageal electrical impedance device is the gold standard for the diagnosis of gastroesophageal reflux disease if the diagnosis is in doubt. In the majority of cases, no treatment is necessary for gastroesophageal reflux apart from reassurance of the benign nature of the condition. Treatment options for gastroesophageal reflux disease are discussed. Conclusion In most cases, no treatment is necessary for gastroesophageal reflux apart from reassurance because the condition is benign and self-limiting. Thickened feedings, postural therapy, and lifestyle changes should be considered if the regurgitation is frequent and problematic. Pharmacotherapy should be considered in the treatment of more severe gastroesophageal reflux disease for patients who do not respond to conservative measures. Proton pump inhibitors are favored over H2-receptor antagonists because of their superior efficacy. Antireflux surgery is indicated for patients with significant gastroesophageal reflux disease who are resistant to medical therapy.
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Affiliation(s)
- Alexander Kc Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.,PICU, The Hong Kong Children's Hospital, Kowloon, Hong Kong
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Abstract
BACKGROUND Gastro-oesophageal reflux (GER) and gastro-oesophageal reflux disease (GERD) are common in infants and children. AIMS To review the recent literature on GERD in children and to outline the approach to diagnosis and management. METHODS A literature search in PubMed was conducted with regard to the prevalence, clinical features, diagnosis and management of GER and GERD in children with special attention to low- and middle-income countries. Articles in English published during the last 25 years, the full text of which was available, were considered and the relevant information extracted. RESULTS Almost 50% of all healthy infants regurgitate at least once a day which peaks at 4 months of age and subsides by 12 months in 90% of cases. Conversely, the prevalence of GERD increases with age and, by adolescence, is similar to that in adults (20%). While GER in infancy does not require investigation or therapy, an empirical proton pump inhibitor (PPI) for 4-8 weeks is justified in older children with classical symptoms of GERD. There is no gold-standard investigation for GERD. In extra-oesophageal manifestations, a pH/impedance is useful and endoscopy in cases with oesophagitis. PPIs play a pivotal role in the management of GERD but have not been found useful in infants with GER. Anti-reflux surgery plays a minor role in GERD owing to the associated morbidity and high failure rate, especially in high-risk groups who most need it. CONCLUSIONS Unless there are warning features such as failure to thrive, haematemesis, abnormal posturing, choking/gagging or coughing while feeding, regurgitation in infancy need not be investigated. In older children and adolescents with typical reflux symptoms, empirical PPI therapy is justified. For extra-oesophageal manifestations, a pH/impedance study and endoscopy to detect oesophagitis are the investigations of choice. PPI is the mainstay of therapy in GERD, but not in GER.
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Affiliation(s)
- Ujjal Poddar
- a Department of Paediatric Gastroenterology , Sanjay Gandhi Postgraduate Institute of Medical Sciences , Lucknow , India
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Shimizu T, Nakayama Y, Ishii E, Ida S, Satou T, Tokuhara D, Arai K, Nii M, Rydholm H, Yajima T. Oral esomeprazole in Japanese pediatric patients with gastric acid-related disease: Safety, efficacy, and pharmacokinetics. Pediatr Int 2019; 61:87-95. [PMID: 30422368 DOI: 10.1111/ped.13733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/10/2018] [Accepted: 11/07/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPI) are widely used for the treatment of gastric acid-related disease, but they are not approved for use in children in Japan. To assess the safety, pharmacokinetics, pharmacodynamics, and efficacy (gastrointestinal symptom improvement) of PPI in Japanese pediatric patients with gastric acid-related disease, we conducted an 8 week, open-label, parallel-group, multicenter, phase I/III study of once-daily oral esomeprazole use. METHODS Japanese children, aged 1-14 years with gastric acid-related disease, were stratified by weight and age into five groups (10 patients/group) to receive esomeprazole as granules for suspension (10 mg) or capsules (10 mg or 20 mg) once daily. RESULTS Esomeprazole was absorbed and eliminated rapidly in all groups, with a median time to reach maximum plasma concentration of 1.47-1.75 h, an arithmetic mean terminal elimination half-life of 0.80-1.37 h, and a weight-correlated apparent total body clearance of 0.216-0.343 L/h/kg. Area under the plasma concentration-time curve during a dosage interval and maximum plasma drug concentration were generally higher in groups given a higher dose (20 mg) or with a lower age/weight, but also in patients identified as poor metabolizers on cytochrome P450 2C19 genotype. Most patients who had any upper gastrointestinal symptoms at baseline were asymptomatic at the end of the study. Thirty-three patients (66%) reported ≥1 adverse events, including three patients who reported serious adverse events not judged to be causally related to esomeprazole. CONCLUSIONS Oral esomeprazole, at 10 mg or 20 mg once daily, had a similar safety, efficacy, and pharmacokinetic profile in Japanese pediatric patients to that previously seen in adults and Caucasian children.
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Affiliation(s)
- Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Matsumoto, Nagano, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Eizaburo Ishii
- Department of Pediatrics, Nagano Prefectural Suzaka Hospital, Suzaka, Nagano, Japan
| | - Shinobu Ida
- Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Tomoki Satou
- Department of Pediatrics, Hiroshima City Funairi Citizens Hospital, Hiroshima, Japan
| | - Daisuke Tokuhara
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Abeno, Tokyo, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Masahiro Nii
- Research and Development, AstraZeneca, Kitaku, Osaka, Japan
| | - Hans Rydholm
- Global Medicine Development, AstraZeneca Gothenburg, Mölndal, Sweden
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Niu CY, Zhou YS, Wu FX. Individualized medicine of gastroesophageal reflux disease. Shijie Huaren Xiaohua Zazhi 2018; 26:2046-2056. [DOI: 10.11569/wcjd.v26.i35.2046] [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] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease (GERD) is a common disease worldwide, and its prevalence is increasing in both developed and developing countries. GERD is divided into three subtypes, namely, erosive esophagitis, nonerosive reflux disease (NERD), and Barrett's esophagus. The etiology, pathogenesis, clinical manifestations, and response to treatment of GERD invariably show high heterogeneity or significant individual difference, especially NERD and refractory GERD. On the other hand, advanced technology has currently provided a wide range of methods for the diagnosis and treatment of GERD patients; however, the long-term efficacy and quality of life of some patients are unsatisfactory. Therefore, each GERD patient needs a specialized management strategy aiming at his/her own condition, which is known as individualized medicine or personalized medicine. The goal of GERD treatment is to relieve the symptoms, while symptomatic remission is directly related to the quality of life. In other words, health-related quality of life and patient satisfaction may be reasonable criteria for GERD. In this paper, we will discuss the individualized medicine of GERD.
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Affiliation(s)
- Chun-Yan Niu
- Department of Gastroenterology, Xiang'an Hospital, Xiamen University, Xiamen 361101, Fujian Province, China
| | - Yong-Shun Zhou
- Department of Gastroenterology, Xiamen University Hospital, Xiamen 361005, Fujian Province, China
| | - Fang-Xiong Wu
- Department of Gastroenterology, the First Affiliated Hospital of Xi'an Medical College, Xi'an 710077, Shaanxi Province, China
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Seo WH, Park M, Eun SH, Rhie S, Song DJ, Chae KY. My child cannot breathe while sleeping: a report of three cases and review. BMC Pediatr 2017; 17:169. [PMID: 28720085 PMCID: PMC5516313 DOI: 10.1186/s12887-017-0922-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sudden breath-holding episodes during sleep in young children are potentially related to sudden infant death syndrome and other life-threatening events. Additionally, these episodes can negatively affect child's growth and development. CASE PRESENTATION Here, we present 3 cases of preschool children with similar paroxysmal nocturnal waking events associated with choking that had different etiologies (nocturnal frontal lobe epilepsy, nocturnal gastroesophageal reflux disease, and parasomnia, respectively). CONCLUSIONS It is important to take into consideration the fact that breath spells during sleep can occur as a rare manifestation of parasomnia due to gastroesophageal reflux or as a symptom of nocturnal frontal lobe epilepsy. Full video electroencephalography, polysomnography, and simultaneous gastric pH monitoring should be used for the differential diagnosis of sleep-related disorders, such as breath spells, in children.
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Affiliation(s)
- Won Hee Seo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Minkyu Park
- Department of Pediatrics, Hanil Medical Center, Seoul, Korea
| | - So-Hee Eun
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Seonkyeong Rhie
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatapro, Seongnam, 13496 GyungGi Province, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Kyu-Young Chae
- Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatapro, Seongnam, 13496 GyungGi Province, Korea.
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Laje P, Blinman TA, Nance ML, Peranteau WH. Laparoscopic fundoplication in neonates and young infants: Failure rate and need for redo at a high-volume center. J Pediatr Surg 2017; 52:257-259. [PMID: 27890313 DOI: 10.1016/j.jpedsurg.2016.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
AIM OF THE STUDY Present the outcomes of patients younger than 2years who underwent laparoscopic fundoplication, highlighting the failure rate and need for redo fundoplication. METHODS Retrospective review of patients <2years who underwent laparoscopic fundoplication between January 2009 and December 2014. MAIN RESULTS 458 infants younger than 2years underwent laparoscopic fundoplication in the 6-year period (360 Nissen, 77 Toupet and 21 Thal fundoplications). Median age at surgery was 5 (1-23) months. Median follow-up was 3 (1-6) years. The conversion rate was 0.87% (4 of 458 cases). Patients did not undergo routine studies to assess the incidence of postoperative GER but were instead followed clinically. Failure of the fundoplication was determined when a patient was unable to gain weight and/or protect the airway while receiving gastric feedings because of GER. The failure rate in our experience was 2.6% (12 redo out of 458 cases [11/360 Nissen, 1/77 Toupet and 0/21 Thal]). All failed cases occurred because of migration of the fundoplication, confirmed preoperatively by a contrast study. Median time between the initial fundoplication and the redo was 13 (5-27) months. There were no failures within a contemporaneous group of 101 patients <2years who underwent open fundoplication. CONCLUSION The need for a redo fundoplication after a laparoscopic fundoplication was an uncommon event in our experience (12 of 458 cases). Our results contrast with published studies that report higher failure rates. Case volume per surgeon may explain in part the dissimilar results among studies. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Pablo Laje
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA.
| | - Thane A Blinman
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA
| | - Michael L Nance
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA
| | - William H Peranteau
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA
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Pascoe E, Falvey T, Jiwane A, Henry G, Krishnan U. Outcomes of fundoplication for paediatric gastroesophageal reflux disease. Pediatr Surg Int 2016; 32:353-61. [PMID: 26646409 DOI: 10.1007/s00383-015-3843-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Outcomes of fundoplication in children. METHODS In this monocentric retrospective study, chart review was performed on children who underwent fundoplication between 2006 and 2013. Outcomes were defined as the need for redo fundoplication and recommencement of anti-reflux medication (ARM) at 6-month follow-up. RESULTS 119 patients underwent fundoplication with a mean age of 4.76 years and 55.5% of these were male. At 6-month follow-up, 21 (17.6%) required redo fundoplication and 64 (53.8%) were recommenced on ARM. Post-operative complications occurred in 50 (42.2%) of children; 30% of those with complications had surgery at less than 1 year of age, and 36% had an associated comorbid condition. Neither being under the age of one nor associated comorbidity was significantly associated with a poor outcome. Concurrent gastrostomy was associated with a higher risk of being back on ARM at 6-month follow-up (p = 0.003). Neither gastrointestinal or respiratory symptoms pre-surgery nor abnormal pre-operative investigations including pH monitoring and endoscopy were predictive of poor outcome post-fundoplication. CONCLUSION Although fundoplication has a role in the treatment of severe GORD in children, the majority of children in this study needed to restart their anti-reflux medications within 6 months of surgery.
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Affiliation(s)
- E Pascoe
- Sydney Children's Hospital Randwick (SCH), Sydney, Australia.
| | - T Falvey
- University of New South Wales (UNSW), Sydney, Australia
| | - A Jiwane
- Department of Paediatric Surgery, SCH, Sydney, Australia
- School of Women's and Children's Health, UNSW, Sydney, Australia
| | - G Henry
- Department of Paediatric Surgery, SCH, Sydney, Australia
| | - U Krishnan
- School of Women's and Children's Health, UNSW, Sydney, Australia
- Department of Paediatric Gastroenterology, SCH, Sydney, Australia
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Lima JJ, Franciosi JP. Pharmacogenomic testing: the case for CYP2C19 proton pump inhibitor gene-drug pairs. Pharmacogenomics 2015; 15:1405-16. [PMID: 25303292 DOI: 10.2217/pgs.14.103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The use of proton pump inhibitors (PPIs) in the treatment of gastroesophageal reflux and related diseases is increasing, especially in the pediatric population. Prolonged use of PPIs has been associated with several adverse effects, including potentially life-threatening gastric and respiratory infections, which are related to dose or to the degree of gastric acid suppression. Genetic variation in the CYP2C19 gene gives rise to poor and extensive metabolizer phenotypes, which influence PPI clearance, efficacy and exposure. A recent paper linked lansoprazole-associated respiratory infections in children with the poor metabolizer phenotype. The case is made for implementing pharmacogenomic testing for the CYP2C19-PPI gene-drug pair and to dose accordingly in order to minimize PPI-associated infections.
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Affiliation(s)
- John J Lima
- Center for Pharmacogenomics & Translational Research, Nemours Children's Clinic, 807 Children's Way, Jacksonville, FL 32207, USA
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Abstract
PURPOSE OF REVIEW Gastroesophageal reflux (GER) remains a common, challenging problem for clinicians, with differentiation of normal development from disease a particular issue. This review updates clinicians on advances in diagnosis of GER, relationship to other problems, and current practice in management. RECENT FINDINGS Development and understanding of multichannel intraluminal impedance-pH monitoring has given insights into the relationship of GER to symptoms. Medical treatment has changed little. Avoidance of overmedicalizing normal development is the major issue for clinicians. Laparoscopic fundoplication is established as equivalent to open fundoplication. Newer endoscopic techniques have only limited use in children to date. SUMMARY Major changes in pediatric GER relate to understanding of physiology and relationship of GER to symptoms. The major challenge for clinicians involve differentiation of normal from abnormal GER, and applying the most relevant management.
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Poddar U. Diagnosis and management of gastroesophageal reflux disease (GERD): An indian perspective. Indian Pediatr 2013; 50:119-26. [DOI: 10.1007/s13312-013-0036-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Solomons N, Nortje N. Treating an intervention level 1 patient: futile or brave? SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2013. [DOI: 10.1080/16070658.2013.11734469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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&NA;. Consider the benefits and limitations of the available options when treating gastro-oesophageal reflux disease. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.2165/11209280-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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