Literature review for - Flourish Paediatrics

(Dwyer and Ponsonby 2009).
Medication
Prokinetic agents which increase lower oesophageal sphincter pressure or enhance gastric
emptying have been utilised in children for gastroesophageal reflux, although there is only
limited data supporting efficacy and the recent expert group conclusion that there is no
justification for their use in routine use (Hegar, Alatas et al. 2009; Vandenplas, Rudolph et al.
2009; Maclennan 2010).
Proton pump inhibitors are widely prescribed for presumed symptoms of GOR. They
effectively decrease acid production, and with this volume of gastric secretions and thus
potentially may decrease refluxate volume, but decrease GOR symptoms only as often as
placebo (Orenstein, Hassall et al. 2009). Proton pump inhibitors increase the risks of a
number of complications, including community acquired pneumonia and enteric infections
and should only be used for extended periods where oesophagitis has been confirmed
(Orenstein, Hassall et al. 2009; Vandenplas, Rudolph et al. 2009).
Surgery
Infants with persistent GOR with serious complications despite medical therapy should be
considered for anti-reflux surgery. It is important to note that anti-reflux surgery can be
lifesaving, but carries risks of significant complications (Vandenplas, Rudolph et al. 2009).
Eosinophilic oesophagitis
There are increasingly recognised babies who have some evidence of allergic disease or
eosinophilic oesophagitis in association with GOR (Cherian, Smith et al. 2006). These
children are often clinically indistinguishable from infants and children with reflux
oesophagitis, and will need detailed assessment including endoscopic biopsy for diagnosis
(Furuta, Liacouras et al. 2007). These infants if formula fed may benefit from switching from
a standard to a hydrolysed formula. Anecdotal evidence suggests that a fully breastfedinfant
with GOR and such features may benefit from maternal dietary elimination of suspected
protein (Vandenplas, Rudolph et al. 2009).
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