The reflex to treat reflux - let’s be conservative regarding gastroesophageal reflux (GER)!

Article Outline

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Standard approaches to infants who regurgitate gastric contents (often the overflow from an overly generous feeding) differ from that recommended for children who reflux and have resultant disease manifestations (GERD). The criteria and strategies are stated in published guidelines (see http://gerd.cdhnf.org/) and are succinctly addressed by Hassall in an editorial in this issue of The Journal. For infants with GER, a rational and conservative approach is to reassure the parents of the benign nature of the “spitting” and perhaps diminish the volume. A key is to set clear expectations regarding the apparent symptoms of GER. As pointed out by Hassall, discomfort, crying, and irritability may have nothing to do with the reflux or acid-induced injury.

In this issue of The Journal, Orenstein and McGowan provide data which should reassure us that these time-trusted methods are effective. Their report is timely given the wide-spread use of acid-inhibitors and pro-motility agents for a myriad of symptoms in infants.

In an analysis of 575000 prescriptions, Medco Health Solutions Inc., a pharmacy benefit manager, determined that the number of acid suppressant medications prescribed for children under 4 years of age increased by 56% between 2002-2006. They estimated that 3% of all children in this age group are prescribed some form of acid suppression medication. This increase may, in part, reflect the rise in the incidence of obesity and the attendant co-morbidity of acid reflux. However, “symptomatic” infants also frequently receive these drugs for presumed GERD; it is this group that would likely best benefit from this conservative approach. The tools are available to all health care providers. The report will likely reduce healthcare costs by decreasing the number of infants referred to subspecialists for evaluation and care.