Treatment options in pediatric GERD

  • Neelesh A. TipnisEmail author
  • Colin D. Rudolph

Opinion statement

Gastroesophageal reflux (GER) is a common physiologic phenomenon in infants and children. GER that results in symptoms or complications—hence the evolution to GER disease (GERD)—warrants targeted evaluation and appropriate treatment. Judicious use of acid-suppression therapy remains the mainstay of pharmacologic treatment of GERD. However, recognition of treatment goals and potentials risks of acid suppression must be considered prior to initiation of therapy. The role of surgical intervention for GERD remains limited.


Omeprazole Esophagitis Baclofen Lower Esophageal Sphincter Lansoprazole 
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.

References and Recommended Reading

  1. 1.
    Rudolph CD, Mazur LJ, Liptak GS, et al.: Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 2001, 32(Suppl 2):S1–S31.PubMedCrossRefGoogle Scholar
  2. 2.
    Martin AJ, Pratt N, Kennedy JD, et al.: Natural history and familial relationships of infant spilling to 9 years of age. Pediatrics 2002, 109:1061–1067.PubMedCrossRefGoogle Scholar
  3. 3.
    Young RJ, Lyden E, Ward B, et al.: A retrospective, case-control pilot study of the natural history of pediatric gastroesophageal reflux. Dig Dis Sci 2007, 52:457–462.PubMedCrossRefGoogle Scholar
  4. 4.
    El-Serag HB, Gilger M, Carter J, et al.: Childhood GERD is a risk factor for GERD in adolescents and young adults. Am J Gastroenterol 2004, 99:806–812.PubMedCrossRefGoogle Scholar
  5. 5.
    Werlin SL, Dodds WJ, Hogan WJ, et al.: Mechanisms of gastroesophageal reflux in children. J Pediatr 1980, 97:244–249.PubMedCrossRefGoogle Scholar
  6. 6.
    Shaker R: Protective mechanisms against supraesophageal GERD. J Clin Gastroenterol 2000, 30:S3–S8.PubMedCrossRefGoogle Scholar
  7. 7.
    Wenzl TG, Schenke S, Peschgens T, et al.: Association of apnea and nonacid gastroesophageal reflux in infants: investigations with the intraluminal impedance technique. Pediatr Pulmonol 2001, 31:144–149.PubMedCrossRefGoogle Scholar
  8. 8.
    Moore DJ, Tao BS, Lines DR, et al.: Double-blind placebocontrolled trial of omeprazole in irritable infants with gastroesophageal reflux. J Pediatr 2003, 143:219–223.PubMedCrossRefGoogle Scholar
  9. 9.
    Orenstein SR, Shalaby TM, Devandry SN, et al.: Famotidine for infant gastro-oesophageal reflux: a multi-centre, randomized, placebo-controlled, withdrawal trial. Aliment Pharmacol Ther 2003, 17:1097–1107.PubMedCrossRefGoogle Scholar
  10. 10.
    Armstrong K, Previtera N, McCallum R: Medicalizing normality? Management of irritability in babies. J Paediatr Child Health 2000, 36:301–305.PubMedCrossRefGoogle Scholar
  11. 11.
    Condino AA, Sondheimer J, Pan Z, et al.: Evaluation of gastroesophageal reflux in pediatric patients with asthma using impedance-pH monitoring. J Pediatr 2006, 149:216–219.PubMedCrossRefGoogle Scholar
  12. 12.
    Peter CS, Sprodowski N, Bohnhorst B, et al.: Gastroesophageal reflux and apnea of prematurity: no temporal relationship. Pediatrics 2002, 109:8–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Rudolph CD: Supraesophageal complications of gastroesophageal reflux in children: challenges in diagnosis and treatment. Am J Med 2003, 115(Suppl 3A):150S–156S.PubMedCrossRefGoogle Scholar
  14. 14.
    Qadeer MA, Swoger J, Milstein C, et al.: Correlation between symptoms and laryngeal signs in laryngopharyngeal reflux. Laryngoscope 2005, 115:1947–1952.PubMedCrossRefGoogle Scholar
  15. 15.
    Krishnan U, Mitchell JD, Tobias V, et al.: Fat laden macrophages in tracheal aspirates as a marker of reflux aspiration: a negative report. J Pediatr Gastroenterol Nutr 2002, 35:309–313.PubMedCrossRefGoogle Scholar
  16. 16.
    Ours TM, Kavuru MS, Schilz RJ, et al.: A prospective evaluation of esophageal testing and a double-blind, randomized study of omeprazole in a diagnostic and therapeutic algorithm for chronic cough. Am J Gastroenterol 1999, 94:3131–3138.PubMedCrossRefGoogle Scholar
  17. 17.
    Fass R, Fennerty MB, Ofman JJ, et al.: The clinical and economic value of a short course of omeprazole in patients with noncardiac chest pain. Gastroenterology 1998, 115:42–49.PubMedCrossRefGoogle Scholar
  18. 18.
    Johnsson F, Weywadt L, Solhaug JH, et al.: One-week omeprazole treatment in the diagnosis of gastro-oesophageal reflux disease. Scand J Gastroenterol 1998, 33:15–20.PubMedCrossRefGoogle Scholar
  19. 19.
    Wenzl TG, Schneider S, Scheele F, et al.: Effects of thickened feeding on gastroesophageal reflux in infants: a placebo-controlled crossover study using intraluminal impedance. Pediatrics 2003, 111:e355–e359.PubMedCrossRefGoogle Scholar
  20. 20.
    Peter CS, Wiechers C, Bohnhorst B, et al.: Influence of nasogastric tubes on gastroesophageal reflux in preterm infants: a multiple intraluminal impedance study. J Pediatr 2002, 141:277–279.PubMedCrossRefGoogle Scholar
  21. 21.
    Kaltenbach T, Crockett S, Gerson LB: Are lifestyle measures effective in patients with gastroesophageal reflux disease? An evidence-based approach. Arch Intern Med 2006, 166:965–971.PubMedCrossRefGoogle Scholar
  22. 22.
    Gerson LB: A little weight gain, how much gastroesophageal reflux disease? Gastroenterology 2006, 131:1644–1646. Discussion 1646.PubMedCrossRefGoogle Scholar
  23. 23.
    Borowitz SM, Sutphen JL: Recurrent vomiting and persistent gastroesophageal reflux caused by unrecognized constipation. Clin Pediatr (Phila) 2004, 43:461–466.CrossRefGoogle Scholar
  24. 24.
    Tran T, Lowry AM, El-Serag HB: Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies. Aliment Pharmacol Ther 2007, 25:143–153.PubMedGoogle Scholar
  25. 25.
    Del Buono R, Wenzl TG, Ball G, et al.: Effect of Gaviscon Infant on gastro-oesophageal reflux in infants assessed by combined intraluminal impedance/pH. Arch Dis Child 2005, 90:460–463.PubMedCrossRefGoogle Scholar
  26. 26.
    Hibbs AM, Lorch SA: Metoclopramide for the treatment of gastroesophageal reflux disease in infants: a systematic review. Pediatrics 2006, 118:746–752.PubMedCrossRefGoogle Scholar
  27. 27.
    Augood C, Gilbert R, Logan S, et al.: Cisapride treatment for gastro-oesophageal reflux in children. Cochrane Database Syst Rev 2002, 3:CD002300.PubMedGoogle Scholar
  28. 28.
    Krach LE: Pharmacotherapy of spasticity: oral medications and intrathecal baclofen. J Child Neurol 2001, 16:31–36.PubMedCrossRefGoogle Scholar
  29. 29.
    Omari TI, Benninga MA, Sansom L, et al.: Effect of baclofen on esophagogastric motility and gastroesophageal reflux in children with gastroesophageal reflux disease: a randomized controlled trial. J Pediatr 2006, 149:468–474.PubMedCrossRefGoogle Scholar
  30. 30.
    Orenstein SR, Blumer JL, Faessel HM, et al.: Ranitidine, 75 mg, over-the-counter dose: pharmacokinetic and pharmacodynamic effects in children with symptoms of gastro-oesophageal reflux. Aliment Pharmacol Ther 2002, 16:899–907.PubMedCrossRefGoogle Scholar
  31. 31.
    Sachs G, Shin JM, Howden CW: Review article: the clinical pharmacology of proton pump inhibitors. Aliment Pharmacol Ther 2006, 23(Suppl 2):2–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Tolia V, Bishop PR, Tsou VM, et al.: Multicenter, randomized, double-blind study comparing 10, 20 and 40 mg pantoprazole in children (5–11 years) with symptomatic gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr 2006, 42:384–391.PubMedCrossRefGoogle Scholar
  33. 33.
    Li J, Zhao J, Hamer-Maansson JE, et al.: Pharmacokinetic properties of esomeprazole in adolescent patients aged 12 to 17 years with symptoms of gastroesophageal reflux disease: a randomized, open-label study. Clin Ther 2006, 28:419–427.PubMedCrossRefGoogle Scholar
  34. 34.
    Zhao J, Li J, Hamer-Maansson JE, et al.: Pharmacokinetic properties of esomeprazole in children aged 1 to 11 years with symptoms of gastroesophageal reflux disease: a randomized, open-label study. Clin Ther 2006, 28:1868–1876.PubMedCrossRefGoogle Scholar
  35. 35.
    Litalien C, Theoret Y, Faure C: Pharmacokinetics of proton pump inhibitors in children. Clin Pharmacokinet 2005, 44:441–466.PubMedCrossRefGoogle Scholar
  36. 36.
    Edwards SJ, Lind T, Lundell L: Systematic review: proton pump inhibitors (PPIs) for the healing of reflux oesophagitis-a comparison of esomeprazole with other PPIs. Aliment Pharmacol Ther 2006, 24:743–750.PubMedCrossRefGoogle Scholar
  37. 37.
    Fossmark R, Johnsen G, Johanessen E, et al.: Rebound acid hypersecretion after long-term inhibition of gastric acid secretion. Aliment Pharmacol Ther 2005, 21:149–154.PubMedCrossRefGoogle Scholar
  38. 38.
    Canani RB, Cirillo P, Roggero P, et al.: Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children. Pediatrics 2006, 117:e817–e820.PubMedCrossRefGoogle Scholar
  39. 39.
    Saiman L, Ludington E, Dawson JD, et al.: Risk factors for Candida species colonization of neonatal intensive care unit patients. Pediatr Infect Dis J 2001, 20:1119–1124.PubMedCrossRefGoogle Scholar
  40. 40.
    Guillet R, Stoll BJ, Cotten CM, et al.: Association of H2-blocker therapy and higher incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics 2006, 117:e137–e142.PubMedCrossRefGoogle Scholar
  41. 41.
    Dial S, Delaney JA, Barkun AN, et al.: Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 2005, 294:2989–2995.PubMedCrossRefGoogle Scholar
  42. 42.
    Bourke B, Ceponis P, Chiba N, et al.: Canadian Helicobacter Study Group Consensus Conference: update on the approach to Helicobacter pylori infection in children and adolescents—an evidence-based evaluation. Can J Gastroenterol 2005, 19:399–408.PubMedGoogle Scholar
  43. 43.
    Ruscin JM, Page RL, 2nd, Valuck RJ: Vitamin B(12) deficiency associated with histamine(2)-receptor antagonists and a proton-pump inhibitor. Ann Pharmacother 2002, 36:812–816.PubMedCrossRefGoogle Scholar
  44. 44.
    Yang YX, Lewis JD, Epstein S, et al.: Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 2006, 296:2947–2953.PubMedCrossRefGoogle Scholar
  45. 45.
    Klinkenberg-Knol EC, Nelis F, Dent J, et al.: Long-term omeprazole treatment in resistant gastroesophageal reflux disease: efficacy, safety, and influence on gastric mucosa. Gastroenterology 2000, 118:661–669.PubMedCrossRefGoogle Scholar
  46. 46.
    Swoger J, Ponsky J, Hicks DM, et al.: Surgical fundoplication in laryngopharyngeal reflux unresponsive to aggressive acid suppression: a controlled study. Clin Gastroenterol Hepatol 2006, 4:433–441.PubMedCrossRefGoogle Scholar
  47. 47.
    Lobe TE: The current role of laparoscopic surgery for gastroesophageal reflux disease in infants and children. Surg Endosc 2007, 21:167–174.PubMedCrossRefGoogle Scholar
  48. 48.
    Lasser MS, Liao JG, Burd RS: National trends in the use of antireflux procedures for children. Pediatrics 2006, 118:1828–1835.PubMedCrossRefGoogle Scholar
  49. 49.
    Esposito C, Montupet P, van Der Zee D, et al.: Longterm outcome of laparoscopic Nissen, Toupet, and Thal antireflux procedures for neurologically normal children with gastroesophageal reflux disease. Surg Endosc 2006, 20:855–858.PubMedCrossRefGoogle Scholar
  50. 50.
    Gilger MA, Yeh C, Chiang J, et al.: Outcomes of surgical fundoplication in children. Clin Gastroenterol Hepatol 2004, 2:978–984.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of PediatricsMedical College of WisconsinMilwaukeeUSA

Personalised recommendations