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European Journal of Pediatrics

, Volume 152, Issue 9, pp 704–711 | Cite as

A proposition for the diagnosis and treatment of gastro-oesophageal reflux disease in children: A report from a working group on gastro-oesophageal reflux disease

  • Y. Vandenplas
  • A. Ashkenazi
  • D. Belli
  • N. Boige
  • J. Bouquet
  • S. Cadranel
  • J. P. Cezard
  • S. Cucchiara
  • C. Dupont
  • K. Geboes
  • F. Gottrand
  • H. S. A. Heymans
  • C. Jasinski
  • C. M. F. Kneepkens
  • S. Koletzko
  • P. Milla
  • J. F. Mougenot
  • D. Nusslé
  • J. Navarro
  • S. J. Newell
  • E. Olafsdottir
  • S. Peeters
  • A. Ravelli
  • I. Polanco
  • B. K. Sandhu
  • J. Tolboom
Review

Abstract

In this paper, a Working Group on Gastro-Oesophageal Reflux discusses recommendations for the first line diagnostic and therapeutic approach of gastro-oesophageal reflux disease in infants and children. All members of the Working Group agreed that infants with uncomplicated gastro-oesophageal reflux can be safely treated before performing (expensive and often unnecessary) complementary investigations. However, the latter are mandatory if symptoms persist despite appropriate treatment. Oesophageal pH monitoring of long duration (18–24 h) is recommended as the investigation technique of choice in infants and children with atypical presentations of gastro-oesophageal reflux. Upper gastro-intestinal endoscopy in a specialised centre is the technique of choice in infants and children presenting with symptoms suggestive of peptic oesophagitis. Prokinetics, still a relatively new drug family, have already obtained a definitive place in the treatment of gastro-oesophageal reflux disease in infants and children, especially if “non-drug” treatment (positional therapy, dietary recommendations, etc.) was unsuccessful. It was the aim of the Working Group to help the paediatrician with this consensus statement and guide-lines to establish a standardised management of gastro-oesophageal reflux disease in infants and children.

Keywords

Public Health Working Group Therapeutic Approach Consensus Statement Standardise Management 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviation

GOR

gastro-oesophageal reflux

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References

  1. 1.
    Arguelles-Martin F, Gonzales-Fernandez F, Gentles MG, Navrro-Merino M (1989) Sucralfate in the treatment of reflux oesophagitis in children: preliminary results. Scand J Gastroenterol 24 [Suppl 156]:43–47Google Scholar
  2. 2.
    Bailey DJ, Andres JM, Danek GD, Pineiro-Carrero VM (1987) Lack of efficacy of thickened feeding as treatment for gastro-esophageal reflux. J Pediatr 110:187–190PubMedGoogle Scholar
  3. 3.
    Ballistreri WF, Farell MK (1983) Gastroesophageal reflux in infants. N Engl J Med 309:790–791PubMedGoogle Scholar
  4. 4.
    Bennett JR (1976) Medical management of gastro-oesophageal reflux. Clin Gastroenterol 5:175–185Google Scholar
  5. 5.
    Berenberg W, Neuhauser EDB (1950) Cardio-esophageal relaxation (chalasia) as a cause of vomiting in infants. Pediatrics 5:414–420Google Scholar
  6. 6.
    Boix-Ochoa J (1986) The physiological approach to the management of gastric esophageal reflux. J Pediatr Surg 21:1932–1939CrossRefGoogle Scholar
  7. 7.
    Buts JP, Barudi C, Otte JB (1987) Double-blind controlled study on the efficacy of sodium-alginate in reducing gastro-esophageal reflux assesed by 24 h continuous pH monitoring in infants and children. Eur J Pediatr 146:156–158PubMedGoogle Scholar
  8. 8.
    Carre IJ (1979) A historical review of the clinical consequences of hiatal hernia (partial thoracic stomach) and gastroesophageal reflux. In: Gellis SS (ed) Gastroesophageal reflux: report of the Ross Conference on pediatric research. Columbus, Ohio, pp 86–94Google Scholar
  9. 9.
    Cecatelli P (1988) Cisapride restores the decreased lower oesophageal sphincter pressure in reflux patients. Gut 29:631–635PubMedGoogle Scholar
  10. 10.
    Corraziari E, Bontempo I, Anzini F (1984) Effect of cisapride on primary peristalsis and lower esophageal sphincter pressure. Gastroenterology 86:1054Google Scholar
  11. 11.
    Cucchiara S, Staiano A, Romaniello G, Capobianco S, Auricchio S (1984) Antacids and cimetidine treatment for gastroesophageal reflux and peptic oesophagitis. Arch Dis Child 59:842–847PubMedGoogle Scholar
  12. 12.
    Cucchiara S, Staiano A, DiLorenzo C (1987) Esophageal motor abnormalities in children with gastroesophageal reflux and peptic esophagitis. Arch Dis Child 62:454–457PubMedGoogle Scholar
  13. 13.
    Dab I, Malfroot A (1988) Gastroesophageal reflux: a primary defect in cystic fibrosis? Scand J Gastroenterol 23 [Suppl 143]:15–31Google Scholar
  14. 14.
    Deprettere A, Van Acker KJ, Du Caju MVL (1987) Increased serum prolactin but normal TSH during preolonged domperidone treatment in children. Eur J Pediatr 146:189–191PubMedGoogle Scholar
  15. 15.
    Fullarton GM, McLauchlan G, Macdonald A, Crean GP, McColl KEL (1989) Rebound nocturnal hypersecretion after four weeks treatment with H2-receptor antagonist. Gut 30:449–454PubMedGoogle Scholar
  16. 16.
    Geboes K, Ectors N, Vantrappen G (1991) Inflammatory disorders of the oesophagus. Hepato-Gastroenterol 38 [Suppl 1] S26–30Google Scholar
  17. 17.
    Grill BB, Hillemeyer A, Semeraro L, McCallum R, Grybosky J (1985) Effects of domperiodone therapy on symptoms and upper gastrointestinal motility in infants with gastroesophageal reflux. J Pediatr 106:311–316PubMedGoogle Scholar
  18. 18.
    Hillemeier AC, Grill BB, McCallum R, Gryboski J (1983) Esophageal and gastric motor abnormalities in gastroesophageal reflux during infancy. Gastroenterology 84:741–745PubMedGoogle Scholar
  19. 19.
    Hillemeier AC, McCallum R, Oertel R, Gryboski J (1986) Effect of bethanechol and metoclopramide on upper gastrointestinal motility in the kitten. J Pediatr Gastroenterol Nutr 5:134–137PubMedGoogle Scholar
  20. 20.
    Holloway RH (1989) Effect of cisapride on postprandial gastro-oesophageal reflux. Gut 30:1187–1193PubMedGoogle Scholar
  21. 21.
    Johansson KE, Boeryd B, Johansson K, Tibbling L (1986) Double-blind cross-over study of ranitidine and placebo in gastroesophageal reflux disease. Scand J Gastroenterol 21:769–778PubMedGoogle Scholar
  22. 22.
    Johnson AG, Lux G (1988) Progress in the treatment of gastrointestinal motility disorders: the role of cisapride. Excerpta MedicaGoogle Scholar
  23. 23.
    Johnson DG (1981) Surgical selection of infants with gastroesophageal reflux. J Pediatr Surg 16 [Suppl 1]:587–594CrossRefPubMedGoogle Scholar
  24. 24.
    Jolley G, Halpern LM, Tunell WP, Johnson DG, Sterling CE (1991) The risk of sudden infant death from gastroesophageal reflux. J Pediatr Surg 26:691–696PubMedGoogle Scholar
  25. 25.
    Kazlow P, Deckelbaum RJ (1988) Gastroesophageal reflux: lessons from children. Gastroenterology 94:1231–1232Google Scholar
  26. 26.
    Koelz HR (1989) Treatment of reflux esophagitis with H2-blockers, antacids, and prokinetic drugs. Scand J Gastroenterol 24 [Suppl 156]:25–36Google Scholar
  27. 27.
    Machida HM, Forbes DA, Gall DG (1988) Metoclopramide in gastroesophageal reflux. J Pediatr 112:483–487PubMedGoogle Scholar
  28. 28.
    Maddern GJ, Kiroff GK, Leppard PI, Jamieson GG (1986) Domperidone, metoclopramide and placebo: all give symptomatic improvement of gastro-oesophageal reflux. J Clin Gastroenterol 8:135–140PubMedGoogle Scholar
  29. 29.
    McHardy G (1978) A multicentric randomized clinical trial of Gaviscon in reflux esophagitis. South Med J 71:16–20PubMedGoogle Scholar
  30. 30.
    Nelis GF, Westerfeld BD (1990) Treatment of resistant oesophagitis in children with omeprazole. Eur J Gastroenterol Hepatol 2:215–218Google Scholar
  31. 31.
    Nusslé D, Genton N, Philippe P (1969) Evolution clinique et radiologique de malpositions cardio-tubérositairs non opérées du nourrisson. Acta Helv Paediatr 24:145–159Google Scholar
  32. 32.
    Orenstein SR, Whitington PF (1982) Positioning for prevention of infant gastroesophageal reflux. Pediatrics 69:768–772PubMedGoogle Scholar
  33. 33.
    Orenstein SR, Whitington PF, Orenstein DM (1983) The infant seat as a treatment for gastroesophage R1 reflux. N Engl J Med 309:709–710PubMedGoogle Scholar
  34. 34.
    Orenstein SR, Magill HL, Brooks P (1987) Thickening of feedings for therapy of gastroesophageal reflux. J Pediatr 110:181–185PubMedGoogle Scholar
  35. 35.
    Reid M (1977) Dystonic reactions to metoclopramide (Maxilon) Ulser Med J 46:38–40Google Scholar
  36. 36.
    Reyntjens AJ, Verlinden M, Aerts T (1986) Development and clinical use of the new gastrointestinal prokinetic drugs Drug Dev Res 8:251–261CrossRefGoogle Scholar
  37. 37.
    Riccobana M, Maurer U, Lackner H, Uray E, Ring E (1992) The role of sonography in the evaluation of gastro-oesophageal reflux-correlation of pH metry. Eur J Pediatr 151:655–657PubMedGoogle Scholar
  38. 38.
    Richter JE, Castell DO (1983) Gastroesophageal reflux disease: pathogenesis, diagnosis and therapy. In: Castell DO, Johnson IF (eds) Esophageal function in health and disease. Elsevier, The Netherlands, pp 152–171Google Scholar
  39. 39.
    Siewert R, Feussner H (1989) Surgical considerations for anti-reflux therapy. Scand J Gastroenterol 24 [Suppl 168]:50–59Google Scholar
  40. 40.
    Sutphen JL, Dillard VL (1988) Effect of ranitidine on twenty-four-hour gastric acidity in infants. J Pediatr 114:472–474Google Scholar
  41. 41.
    Stanciu C, Bennett JR (1974) Oesophageal acid clearing: one factor in the prediction of reflux oesophagitis. Gut 15:852–857PubMedGoogle Scholar
  42. 42.
    Vandenplas Y (1992) Oesophageal pH monitoring for gastroesophageal reflux in infants and children. J. Wiley and Sons, EnglandGoogle Scholar
  43. 43.
    Vandenplas Y, Belli D, Boige N, Bouquet J, Cadranel S, Cezard JP, Chapoy P, Cucchiara S, Dupont C, Gottrand F, Heymans HSA, Kneepkens CMF, Katsiayannikis L, Milla P, Navarro J, Newell SJ, Sandhu BK, Tolboom J (1992) A standardized protocol for the methodology of esophageal pH monitoring and interpretation of the data for the diagnosis of gastroesophageal reflux. ESPGAN-Society Statement. J Pediatr Gastroenterol Nutr 14:467–471PubMedGoogle Scholar
  44. 44.
    Wilson CM (1987) Methemoglobinemia following metoclopramide therapy in an infant. J Pediatr Gastroenterol Nutr 6:640–642PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • Y. Vandenplas
    • 18
  • A. Ashkenazi
    • 1
  • D. Belli
    • 2
  • N. Boige
    • 3
  • J. Bouquet
    • 4
  • S. Cadranel
    • 5
  • J. P. Cezard
    • 3
  • S. Cucchiara
    • 6
  • C. Dupont
    • 7
  • K. Geboes
    • 8
  • F. Gottrand
    • 9
  • H. S. A. Heymans
    • 10
  • C. Jasinski
    • 11
  • C. M. F. Kneepkens
    • 12
  • S. Koletzko
    • 13
  • P. Milla
    • 14
  • J. F. Mougenot
    • 15
  • D. Nusslé
    • 2
  • J. Navarro
    • 3
  • S. J. Newell
    • 16
  • E. Olafsdottir
    • 17
  • S. Peeters
    • 18
  • A. Ravelli
    • 19
  • I. Polanco
    • 20
  • B. K. Sandhu
    • 21
  • J. Tolboom
    • 22
  1. 1.Kaplan Hospital RehovotIsrael
  2. 2.Hôpital Cantonal UniversitaireGenèveSwitzerland
  3. 3.Hôpital Robert DebréParisFrance
  4. 4.Sophia Children HospitalRotterdamThe Netherlands
  5. 5.Hôpital Universitaire Des EnfantsBruxellesBelgique
  6. 6.Universita Degli Studi di NapoliNapoliItaly
  7. 7.Hôpital Saint Vincent de PaulParisFrance
  8. 8.U.Z. GasthuisbergLeuvenBelgium
  9. 9.CHRU LilleFrance
  10. 10.Academisch Ziekenhuis GroningenGroningenThe Netherlands
  11. 11.Centro PediatricoMontevideoUruguay
  12. 12.Vrije UniversiteitAmsterdamThe Netherlands
  13. 13.Heinrich-Heine-UniversitätDüsseldorf 1Germany
  14. 14.Institute of Child HealthLondonUK
  15. 15.Hôpital des Enfants MaladesParisFrance
  16. 16.Birmingham Maternity HospitalBirminghamUK
  17. 17.BarnklinikenBergenNorway
  18. 18.Academisch Ziekenhuis Vrije Universiteit BrusselBrusselsBelgium
  19. 19.Spedali CiviliBresciaItaly
  20. 20.Universidad Autonoma de MadridMadridSpain
  21. 21.Royal Hospital St. Michaels' HillBristolUK
  22. 22.StRadboud Academisch Ziekenhuis NijmegenNijmegenThe Netherlands

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