Journal Mobile Options
Table of Contents
Vol. 69, Suppl. 1, 2004
Issue release date: March 2004
Digestion 2004;69(suppl 1):3–8
(DOI:10.1159/000076370)

Managing Gastro-Oesophageal Reflux Disease in Children

Cezard J.P.
Department of Paediatric Gastroenterology and Nutrition, Robert Debré Hospital, Paris, France

Individual Users: Register with Karger Login Information

Please create your User ID & Password





Contact Information











I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in

Abstract

Gastro-oesophageal reflux (GOR) and gastro-oesophageal reflux disease (GORD) have a higher prevalence among infants than among children or adults. This is linked to the immaturity of the oesophagus and stomach and the higher liquid intake of infants. Genetic factors could also be contributory in some families. Clinical symptoms in infants are mainly regurgitation and vomiting, which usually disappear between 1 and 3 years of age. Symptoms in children are similar to those in adults. Treatment in children depends on age and GORD severity. With GOR or mild GORD, particularly in infants, explanation and reassurance together with thickening of formula feed and lifestyle changes are usually effective. Prokinetics either have unproven efficacy (metoclopramide, domperidone) or have been withdrawn (cisapride). Chronic antacid therapy is not recommended. In moderate to severe GORD, histamine-2-receptor antagonists and particularly proton pump inhibitors (PPIs) are effective, especially when oesophagitis is present. PPIs, in particular omeprazole and lansoprazole, have proven efficacy in infants and children. They are well tolerated, with pharmacokinetics similar to those in adults. However, dosages should be adapted in neonates and children under 10 years old. Fundoplication should be avoided before 2 to 3 years of age if possible.



Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Shepherd RW, Wren J, Evans S, Lander M, Ong TH: Gastroesophageal reflux in children. Clinical profile, course and outcome with active therapy in 126 cases. Clin Pediatr (Phila) 1987;26:55–60.
  2. Treem WR, Davis PM, Hyams JS: Gastroesophageal reflux in the older child: presentation, response to treatment and long-term follow-up. Clin Pediatr (Phila) 1991;30:435–440.
  3. Vandenplas Y: Hiatal hernia and gastro- oesophageal reflux; in Buts JP, Sokal EM (eds): Management of Digestive and Liver Disorders in Infants and Children, Elsevier Science 1993, vol 9, pp 103–116.
  4. Newell SJ, Sarkar PK, Durbin GM, Booth IW, McNeish AS: Maturation of the lower oesophageal sphincter in the preterm baby. Gut 1988;29:167–172.
  5. Omari TI, Miki K, Fraser R, Davidson G, Haslam R, Goldsworthy W, Bakewell M, Kawahara H, Dent J: Esophageal body and lower oesophageal sphincter function in healthy premature infants. Gastroenterology 1995;109:1757–1764.
  6. Vandenplas Y, Hassall E: Mechanisms of gastroesophageal reflux and gastroesophageal reflux disease. J Paediatr Gastroenterol Nutr 2002;35:119–136.
  7. Cameron AJ, Lagergren J, Henriksson C, Nyren O, Locke GR, Pedersen NL: Gastroesophageal reflux disease in monozygotic and dizygotic twins. Gastroenterology 2002;122:55–59.
  8. Orenstein SR, Shalaby TM, Barmada MM, Whitcomb DC: Genetics of gastroesophageal reflux disease: a review. J Pediatr Gastroenterol Nutr 2002;34:506–510.
  9. El-Serag HB, Gilger M, Kuebeler M, Rabeneck L: Extraesophageal associations of gastroesophageal reflux disease in children without neurologic defects. Gastroenterology 2001;121:1294–1299.
  10. Nelson SP, Chen EH, Syniar GM, Christoffel KK: Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 1997;151:569–572.
  11. Nelson SP, Chen EH, Syniar GM, Christoffel KK: Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 2000;154:150–154.
  12. Hassall E: Co-morbidities in childhood Barrett’s esophagus. J Pediatr Gastroenterol Nutr 1997;25:255–260.
  13. Lieberman DA, Oehlke M, Helfand M: Risk factors for Barrett’s esophagus in community-based practice. GORGE Consortium. Gastroenterology Outcomes Research Group in Endoscopy. Am J Gastroenterol 1997;92:1293–1297.
  14. Lagergren J, Bergstrom R, Lindgren A, Nyren O: Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825–831.
  15. Waring JP, Feiler MJ, Hunter JG, Smith CD, Gold BD: Childhood gastroesophageal reflux symptoms in adult patients. J Pediatr Gastroenterol Nutr 2002;35:334–338.
  16. Vandenplas Y, Belli D, Cadranel S, Cucchiara S, Dupont C, Heyman SH, Polanco I: Dietary treatment for regurgitation – recommendations from a working party. Acta Paediatr 1998;87:462–468.
  17. Rudolph CD, Mazur LJ, Liptak GS, Baker RD, Boyle JT, Colletti RB, Gerson WT, Werlin SL: 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.
  18. Rode H, Stunden RJ, Millar AJ, Cywes S: Esophageal pH assessment of gastroesophageal reflux in 18 patients and the effect of two prokinetic agents: cisapride and metoclopramide. J Pediatr Surg 1987;22:931–934.
  19. Kelly DA: Do H2 receptor antagonists have a therapeutic role in childhood? J Paediatr Gastroenterol Nutr 1994;19:270–276.
  20. Tolia V, Ferry G, Gunasekaran T, Huang B, Keith R, Book L: Efficacy of lansoprazole in the treatment of gastroesophageal reflux disease in children. J Paediatr Gastroenterol Nutr 2002;35(suppl 4):S308–S318.
  21. Hassall E, Israel D, Shepherd R, Radke M, Dalvag A, Skold B, Junghard O, Lundborg P: Omeprazole for treatment of chronic erosive esophagitis in children: a multicenter study of efficacy, safety, tolerability and dose requirements. International Pediatric Omeprazole Study Group. J Pediatr 2000;137:800–807.
  22. Andersson T, Hassall E, Lundborg P, Sheperd R, Radke M, Marcon M, Dalvag A, Martin S, Behrens R, Koletzko S, Becker M, Drouin E, Gothberg G: Pharmacokinetics of orally administered omeprazole in children. International Pediatric Omeprazole Pharmacokinetic Group. Am J Gastroenterol 2000:95:3101–3106.
  23. Faure C, Michaud L, Shaghaghi EK, Popon M, Laurence M, Mougenot JF, Hankard R, Navarro J, Jacoz-Aigrain E: Lansoprazole in children: pharmacokinetics and efficacy in reflux oesophagitis. Aliment Pharmacol Ther 2001;15:1397–1402.
  24. Baldi F, Malfertheiner P: Lansoprazole fast disintegrating tablet: a new formulation for an established proton pump inhibitor. Digestion 2003;67:1–5.
  25. Fonkalsrud EW, Ashcraft KW, Coran AG, Ellis DG, Grosfeld JL, Tunell WP, Weber TR: Surgical treatment of gastroesophageal reflux in children: a combined hospital study of 7,467 patients. Pediatrics 1998;101:419–422.


Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50