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Italian survey on general pediatricians’ approach to children with gastroesophageal reflux symptoms

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Abstract

The aim of the present study was to investigate the current approach of Italian general pediatricians to children with gastroesophageal reflux (GER) symptoms, evaluating the implementation of the 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines. One hundred randomly identified Italian general pediatricians were asked to complete a case report-structured questionnaire investigating their approach to infants, children, and adolescents with symptoms suggestive of GER. Only 2 % of them showed complete adherence to the guidelines. Thirty-nine percent of them diagnosed GER disease based on clinical symptoms, irrespective of the age of the child; 56 % prescribed proton pump inhibitors (PPIs) in infants with unexplained crying and/or distressed behavior and 38 % in infants with uncomplicated recurrent regurgitation and vomiting; 57 % prescribed PPIs in children younger than 8–12 years of age with vomiting and heartburn, without specific testing; and 54 % discontinued PPI therapy abruptly. The overall rate of pediatricians over-prescribing PPIs was 79 %. Conclusion: According to our findings, most Italian general pediatricians do not seem to follow the recommendations of the 2009 NASPGHAN-ESPGHAN reflux guidelines and often prescribe PPIs despite a lack of efficacy for the symptoms being treated. We are well aware that the guidelines address the average situation and that the evaluation of individual patients may frequently reveal reasons for opening criteria for exceptions. Nevertheless, the over-diagnosis of gastroesophageal reflux disease (GERD) places undue burden on both families and national health system which has not been impacted by the publication of international guidelines.

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Abbreviations

ESPGHAN:

European Society for Pediatric Gastroenterology, Hepatology, and Nutrition

GER:

Gastroesophageal reflux

GERD:

Gastroesophageal reflux disease

H2RAs:

Histamine-2 receptor antagonists

NASPGHAN:

North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

PPIs:

Proton pomp inhibitors

US:

Ultrasonography

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Acknowledgments

A warm thanks is addressed to all Italian pediatricians who have voluntarily and freely participated in the survey.

Conflict of interest

Paolo Quitadamo, Erasmo Miele, Angelo Alongi, Francesco Paolo Brunese, Maria Elisabetta Di Cosimo, Dante Ferrara, Silvia Gambotto, Adima Lamborghini, Maddalena Mercuri, Angela Pasinato, Renato Sansone, Concetta Vitale, Alberto Villani, and Annamaria Staiano as authors of the manuscript state that they neither have any conflict of interest nor financial relationship to disclose.

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Authors and Affiliations

  1. Department of Translational Medical Sciences, Section of Pediatrics, University “Federico II”, Naples, Italy

    Paolo Quitadamo, Erasmo Miele & Annamaria Staiano

  2. ASP Palermo 6, Palermo, Italy

    Angelo Alongi & Dante Ferrara

  3. ASL Caserta, Caserta, Italy

    Francesco Paolo Brunese

  4. ASL Milano 1, Milan, Italy

    Maria Elisabetta Di Cosimo

  5. ASL Torino 4, Turin, Italy

    Silvia Gambotto

  6. ASL Teramo, Teramo, Italy

    Adima Lamborghini

  7. ASL Roma D, Rome, Italy

    Maddalena Mercuri

  8. ASL Vicenza 6, Vicenza, Italy

    Angela Pasinato

  9. ASL Avellino, Avellino, Italy

    Renato Sansone

  10. ASP Palermo 206, Palermo, Italy

    Concetta Vitale

  11. Ospedale Pediatrico Bambino Gesù, Rome, Italy

    Alberto Villani

Authors
  1. Paolo Quitadamo
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  2. Erasmo Miele
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  12. Concetta Vitale
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  13. Alberto Villani
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  14. Annamaria Staiano
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Corresponding author

Correspondence to Annamaria Staiano.

Additional information

Communicated by Peter de Winter

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Quitadamo, P., Miele, E., Alongi, A. et al. Italian survey on general pediatricians’ approach to children with gastroesophageal reflux symptoms. Eur J Pediatr 174, 91–96 (2015). https://doi.org/10.1007/s00431-014-2369-4

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  • DOI: https://doi.org/10.1007/s00431-014-2369-4

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