Live from the GI Conference: New GERD Treatment Guidelines
The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) is in the process of updating the guidelines doctors use to treat infants and children with Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD). The previous guidelines were developed in 2001 and much has changed in the field since then. The committee examined research data related to definitions, diagnosis and treatment. The need for new guidelines emerges from new knowledge in the field and growing concern that children and especially infants may be over diagnosed and treated for GERD. It is estimated that an alarming .5% of all infants in the United States per year may be prescribed a Proton Pump Inhibitor or PPI medication for GERD with little information on the need, safety and effectiveness of these medications in infancy.
One important study looked at infants ages 1-12 months who still had persistent symptoms after a trial of non medication treatment for GERD. One group was given a PPI medication and the other was given a placebo (note: a placebo is a medication that looks like a pill or capsule but does not contain any medication). Caregivers were not told if their child was receiving the medication or the placebo and tracked their baby’s symptoms in a diary. In both groups (babies given medication, babies given a placebo) there was a 50% decrease in crying related to feeding. Whether or not the baby received GERD medication, 50% were judged by their caregivers as improved. In essence, no medication was just as effective as medication. A more worrisome finding was that 62% of the children who received medication had side effects (compared to 46% of the placebo group) with a small group having serious side effects (respiratory infection). The researchers suggest that PPI medication should not be given to infants under the age of one year based on symptoms alone (a crying infant).
Important: Before you stop reading this blog and race to the phone to call the doctor, read on. While this is important date, it does not mean that you should stop the medication right now and page the gastroenterologist on call. It will take a bit more time to determine exactly which infants will benefit from the PPI’s or an alternative medication such as a H2 blocker medication. Meanwhile, you should continue following the doctors treatment plan. However, in the near future, doctors and patients may be introduced to new treatment strategies based on these findings. The bottom line is many infants and children benefit from the PPI medication. My daughter has significant respiratory complications, including aspiration and the PPI medications healed her esophagitis and calmed her breathing.
Another study looked at non medication treatment of GERD in infancy. Parents were taught home care techniques for feeding, positioning and avoiding tobacco smoke (a known trigger for reflux in infancy). After two weeks, 78% improved on measures of symptoms and 24% were considered “normal”.
We will need to wait until 2009 to see the new GERD treatment guidelines. It is anticipated that there will be changes in the definitions similar to the format for adult treatment guidelines recently adopted by the American College of Gastroenterology. Further, there will be new information on symptoms, testing and treatment based on recent studies.
The presentation of the new guidelines generated a lively discussion among the doctors attending the conference. It is likely that Reflux Moms and Dads will keep the on line discussion boards busy with their worries, concerns and ideas about these new treatment guidelines too. Let me hear your thoughts on these studies and what you think should be addressed in the new guidelines.