Pediatric Gastroesophageal Reflux Disease (GERD): A Literature Review

Authors

  • Farahdina Shahnaz Gastrohepatology Division, Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Yuda Satrio Wicaksono Gastrohepatology Division, Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Himawan Aulia Rahman Gastrohepatology Division, Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

DOI:

https://doi.org/10.58427/apghn.2.2.2023.46-60

Keywords:

GERD, Reflux, H2RA, PPI

Abstract

Background: Gastroesophageal reflux disease (GERD) is a condition where stomach contents reflux into the esophagus, causing discomfort and complications. It is most prevalent in infants (26.9%) and lesser in children under 10 (3.2%) and over 10 years old (10.1%).

Discussion: GERD is caused by frequent relaxations of the lower esophageal sphincter (LES), allowing stomach contents to escape into the esophagus. Symptoms vary with age, with infants experiencing regurgitation and irritability, while older children may have heartburn and nausea. Diagnosis requires differentiating GERD from similar conditions and may involve various tests, though their primary use lacks sufficient evidence. Nonpharmacological treatments include thickened feeding, reducing feeding volume but increasing frequency and possibly eliminating cow's milk protein. Pharmacological treatments include Proton Pump Inhibitors (PPIs), and Histamine Receptor Antagonists (H2RAs), though their efficacy varies. Prokinetics are generally not recommended due to lack of evidence. If all these treatments fail, anti-reflux surgery such as fundoplication can be considered.

Conclusion: The hallmark of GERD is the presence of esophagitis during endoscopy. However, Barrett’s esophagus is rare in pediatric GERD patients. Factors indicating a worse prognosis include early onset age, an initial GERD diagnosis, and the need for PPI or combination of H2RA and PPI treatment.

References

Leung AK, Hon KL. Gastroesophageal reflux in children: an updated review. Drugs in context. 2019;8. https://doi.org/10.7573/dic.212591

Poddar U. Gastroesophageal reflux disease (GERD) in children. Paediatrics and international child health. 2019;39(1):7-12. https://doi.org/10.1080/20469047.2018.1489649

Rosen R, Vandenplas Y, Singendonk M, Cabana M, Di Lorenzo C, Gottrand F, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). Journal of pediatric gastroenterology and nutrition. 2018;66(3):516. https://doi.org/10.1097/MPG.0000000000001889

Singendonk M, Goudswaard E, Langendam M, van Wijk M, van Etten-Jamaludin F, Benninga M, et al. Prevalence of gastroesophageal reflux disease symptoms in infants and children: a systematic review. Journal of Pediatric Gastroenterology and Nutrition. 2019;68(6):811-7. https://doi.org/10.1097/MPG.0000000000002280

McLoughlin VZ, Suaini NH, Siah K, Loo EX, Pang WW, Chong YS, et al. Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore. Annals of the Academy of Medicine, Singapore. 2022;51(5):263-71. https://doi.org/10.47102/annals-acadmedsg.2021411

Friedman C, Sarantos G, Katz S, Geisler S. Understanding gastroesophageal reflux disease in children. Jaapa. 2021;34(2):12-8. https://doi.org/10.1097/01.JAA.0000731488.99461.39

Sintusek P, Mutalib M, Thapar N. Gastroesophageal reflux disease in children: What’s new right now? World Journal of Gastrointestinal Endoscopy. 2023;15(3):84

Omari TI, Rommel N, Staunton E, Lontis R, Goodchild L, Haslam RR, et al. Paradoxical impact of body positioning on gastroesophageal reflux and gastric emptying in the premature neonate. J Pediatr. 2004;145(2):194-200. https://doi.org/10.1016/j.jpeds.2004.05.026

Vandenplas Y, De Schepper J, Verheyden S, Devreker T, Franckx J, Peelman M, et al. A preliminary report on the efficacy of the Multicare AR-Bed in 3-week-3-month-old infants on regurgitation, associated symptoms and acid reflux. Arch Dis Child. 2010;95(1):26-30. https://doi.org/10.1136/adc.2008.156497

van Wijk MP, Benninga MA, Dent J, Lontis R, Goodchild L, McCall LM, et al. Effect of body position changes on postprandial gastroesophageal reflux and gastric emptying in the healthy premature neonate. J Pediatr. 2007;151(6):585-90, 90.e1-2. https://doi.org/10.1016/j.jpeds.2007.06.015

Horvath A, Dziechciarz P, Szajewska H. The effect of thickened-feed interventions on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized, controlled trials. Pediatrics. 2008;122(6):e1268-e77. https://doi.org/10.1542/peds.2008-1900

Salvatore S, Savino F, Singendonk M, Tabbers M, Benninga MA, Staiano A, et al. Thickened infant formula: What to know. Nutrition. 2018;49:51-6. https://doi.org/https://doi.org/10.1016/j.nut.2017.10.010

Winter H, Kum-Nji P, Mahomedy SH, Kierkus J, Hinz M, Li H, et al. Efficacy and safety of pantoprazole delayed-release granules for oral suspension in a placebo-controlled treatment-withdrawal study in infants 1–11 months old with symptomatic GERD. Journal of pediatric gastroenterology and nutrition. 2010;50(6):609-18. https://doi.org/10.1097/MPG.0b013e3181c2bf41

Ummarino D, Miele E, Martinelli M, Scarpato E, Crocetto F, Sciorio E, et al. Effect of magnesium alginate plus simethicone on gastroesophageal reflux in infants. Journal of pediatric gastroenterology and nutrition. 2015;60(2):230-5. https://doi.org/10.1097/MPG.0000000000000521

Miller S. Comparison of the efficacy and safety of a new aluminium-free paediatric alginate preparation and placebo in infants with recurrent gastroesophageal reflux. Current medical research and opinion. 1999;15(3):160-8. https://doi.org/10.1185/03007999909114087

Orenstein SR, Hassall E, Furmaga-Jablonska W, Atkinson S, Raanan M. Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. The Journal of pediatrics. 2009;154(4):514-20. e4. https://doi.org/10.1016/j.jpeds.2008.09.054

Davidson G, Wenzl TG, Thomson M, Omari T, Barker P, Lundborg P, et al. Efficacy and safety of once-daily esomeprazole for the treatment of gastroesophageal reflux disease in neonatal patients. The Journal of pediatrics. 2013;163(3):692-8. e2. https://doi.org/10.1016/j.jpeds.2013.05.007

Hussain S, Kierkus J, Hu P, Hoffman D, Lekich R, Sloan S, et al. Safety and efficacy of delayed release rabeprazole in 1-to 11-month-old infants with symptomatic GERD. Journal of pediatric gastroenterology and nutrition. 2014;58(2):226-36. https://doi.org/10.1097/MPG.0000000000000195

Moore DJ, Tao BS-K, Lines DR, Hirte C, Heddle ML, Davidson GP. Double-blind placebo-controlled trial of omeprazole in irritable infants with gastroesophageal reflux. The Journal of pediatrics. 2003;143(2):219-23. https://doi.org/10.1067/S0022-3476(03)00207-5

Cucchiara S, Gobio-Casali L, Balli F, Magazzu G, Staiano A, Astolfi R, et al. Cimetidine treatment of reflux esophagitis in children: an Italian multicentric study. Journal of pediatric gastroenterology and nutrition. 1989;8(2):150-6

Orenstein S, Blumer J, Faessel H, McGuire J, Fung K, Li B, et al. Ranitidine, 75 mg, over‐the‐counter dose: pharmacokinetic and pharmacodynamic effects in children with symptoms of gastro‐oesophageal reflux. Alimentary pharmacology & therapeutics. 2002;16(5):899-907.https://doi.org/10.1046/j.1365-2036.2002.01243.x

Simeone D, Caria MC, Miele E, Staiano A. Treatment of childhood peptic esophagitis: a double-blind placebo-controlled trial of nizatidine. Journal of pediatric gastroenterology and nutrition. 1997;25(1):51-5

Cucchiara S, Minella R, Iervolino C, Franco M, Campanozzi A, Franceschi M, et al. Omeprazole and high dose ranitidine in the treatment of refractory reflux oesophagitis. Archives of Disease in Childhood. 1993;69(6):655-9

Ummarino D, Miele E, Masi P, Tramontano A, Staiano A, Vandenplas Y. Impact of antisecretory treatment on respiratory symptoms of gastroesophageal reflux disease in children. Diseases of the Esophagus. 2012;25(8):671-7. https://doi.org/10.1111/j.1442-2050.2011.01301.x

Omari TI, Benninga MA, Sansom L, Butler RN, Dent J, Davidson GP. Effect of baclofen on esophagogastric motility and gastroesophageal reflux in children with gastroesophageal reflux disease: a randomized controlled trial. The Journal of pediatrics. 2006;149(4):468-74. e2. https://doi.org/10.1016/j.jpeds.2006.05.029

Tolia V, Gilger MA, Barker PN, Illueca M. Healing of erosive esophagitis and improvement of symptoms of gastroesophageal reflux disease after esomeprazole treatment in children 12 to 36 months old. Journal of pediatric gastroenterology and nutrition. 2010;51(5):593-8. https://doi.org/10.1097/MPG.0b013e3181ddcf11

Slater BJ, Dirks RC, McKinley SK, Ansari MT, Kohn GP, Thosani N, et al. SAGES guidelines for the surgical treatment of gastroesophageal reflux (GERD). Surgical Endoscopy. 2021;35:4903-17. https://doi.org/https://doi.org/10.1007/s00464-021-08625-5

Mauritz FA, van Herwaarden-Lindeboom MY, Stomp W, Zwaveling S, Fischer K, Houwen RH, et al. The effects and efficacy of antireflux surgery in children with gastroesophageal reflux disease: a systematic review. Journal of Gastrointestinal Surgery. 2011;15:1872-8. https://doi.org/10.1007/s11605-011-1644-1

Published

2023-05-31

How to Cite

1.
Pediatric Gastroesophageal Reflux Disease (GERD): A Literature Review. Arch Pediatr Gastr Hepatol Nutr [Internet]. 2023 May 31 [cited 2024 Oct. 6];2(2):46-60. Available from: https://apghn.com/index.php/journal/article/view/40