Table 3.
Diagnostic and therapeutic management of gastroesophageal reflux disease in pediatric patients with cystic fibrosis
| Infants | Children | |
| Typical symptoms | Excessive crying, back arching, regurgitation, irritability | Heartburn, regurgitation |
| Diagnostic test | ||
| Indication | ||
| PPIs trial | Not indicated; Exclude anatomically abnormalities | 12 year-old children with typical symptoms. Not use a trial of PPIs as a diagnostic test for GERD in patients presenting with extraesophageal symptoms |
| Barium swallow | Not indicated, useful to exclude anatomical abnormalities | Not indicated, useful to exclude anatomical abnormalities |
| Endoscopy | Indicated in the presence of the alarm symptoms or to detect complications of GERD; to diagnose conditions that predispose or mimic GERD | Indicated in the presence of alarm symptoms or to detect complications of GERD, to diagnose conditions that predispose to GERD (such as hiatal hernia) or to diagnose conditions that might mimic GERD (such as eosinophilic esophagitis, infectious esophagitis) |
| Esophageal manometry | Not indicated | |
| Not indicated | ||
| Not indicated | ||
| Scintigraphy | Not indicated | |
| Correlate persistent | ||
| Ph-MII | Extraesophageal symptoms with acid and non-acid GER events; Determine the efficacy of acid suppression therapy. Differentiate NERD, hypersensitive oesophagus and functional heartburn in patients with normal endoscopy | Correlate persistent extraesophageal symptoms with acid and non-acid GER events. Determine the efficacy of acid suppression therapy. Differentiate NERD, hypersensitive oesophagus and functional heartburn in patients with normal endoscopy |
| Therapy | ||
| Alginate | Absence of evidence | Absence of evidence |
| PPIs | First-line treatment of reflux-related erosive esophagitis with GERD | First line of treatment in children with typical symptoms of GERD, and erosive esophagitis with GERD |
| Prokinetics | Not indicated | Not indicated |
| Fundoplication | Life-threatening complications of GERD after failure of optimal medical treatment; chronic conditions (i.e. neurologically impaired, cystic fibrosis) with a significant risk of GERD-related complications | Life-threatening complications of GERD after failure of optimal medical treatment; Chronic conditions (i.e. neurologically impaired, cystic fibrosis) with a significant risk of GERD-related complications |
| GERD-related complications | Barrett’s esophagus | Barrett’s esophagus |
PPIs: Proton pump inhibitors; GERD: Gastroesophageal reflux disease.