- Vandenplas, Y. et al. Infant gastroesophageal reflux disease management consensus. Acta Paediatrica 113, 403–410 (2024). (Last website visit: 17. May 24)
Possible reflux disease (GERD) is one of the most common reasons for an outpatient presentation in paediatric gastroenterology. As the symptoms in infants are unspecific, GERD is often overdiagnosed and many infants are prescribed acid-suppressing medication without any clear evidence of acid-related disease.
A panel of 18 experts in paediatric gastroenterology recently published some consensus statements and recommendations.1 One of the key messages is that gastroesophageal reflux in infants is usually benign, and in almost all cases resolves without intervention by the end of the first year of life. In many cases, the best course of action is to reassure parents and, if necessary, recommend dietary changes, e.g. smaller, more frequent meals.
However, if the reflux is associated with complications that affect quality of life, such as failure to thrive and oesophagitis, then reflux disease (GERD) is present. Diagnostic clarification may be indicated, especially if the symptoms persist. The pH value of the refluxate is a decisive factor here.
In the smaller subgroup of infants requiring treatment, the majority have a weakly acidic (pH 4-7) or non-acidic refluxate (pH > 7). The efficacy and safety profiles of proton pump inhibitors and H2 receptor antagonists do not justify their use in non-acidic reflux. There is also little evidence for the use of prokinetics in infant reflux, but there are potential side effects, according to the experts.
There is an unmet need in the management of some infants with non-acid reflux. In non-breastfed infants, thickening agents are a suitable treatment for symptomatic non-acid reflux. The addition of a thickener to expressed breast milk is preferable to discontinuing breastfeeding.
Thickeners are generally considered to be well tolerated, but there are concerns about possible minimal exposure to arsenic, changes in the microbiome and malabsorption of micronutrients, according to the published findings.
The panel cites alginate as a potential treatment option for mildly acidic or non-acidic paediatric reflux, as it reduces symptoms and reflux episodes with a rapid onset of action. As a limitation, the authors themselves admit that the study situation on the clinical benefit still needs to be improved. Although alginate brought about a significant improvement in the average level of reflux in infants, the difference compared to placebo was marginal. The publication of the expert panel was supported by Reckitt Benckiser, one of the market leaders for alginate and antacids against heartburn.