Table 4. Key recommendations from the quality “High-” clinical practice guidelines.
| Clinical topic | Key takeaways | |
|---|---|---|
| Defining GER and GERD | GERD should be diagnosed only when symptoms become troublesome or lead to potentially dangerous or long-term complications [25,26,28] | |
| Treatment of GER | Effortless vomiting is common among infants, and appropriate treatment should emphasize empathetic parental reassurance. The more aggressive treatments indicated for GERD should be avoided [26,28] | |
| Signs & symptoms of GERD | Presenting symptoms vary between infants, younger children, and older children. Older children tend to present with heartburn and epigastric pain as is associated with adult GERD, while infants and younger children present with more variable symptoms, such as emesis, arching of the back, crying, and irritability [25,28] | |
| Red flag signs & symptoms | Red flag symptoms that suggest an alternate diagnosis include projectile vomiting, weight loss, nocturnal vomiting, systemic symptoms, or onset of vomiting at >6 months of age, among many others [26,28]. These signs and symptoms indicate the need for a referral to a relevant specialist [26]. | |
| Non-pharmacological treatment of GERD | Infants | |
| • Indicated: thickened formula [26,28] | ||
| • Not indicated: positional therapy [26,28] | ||
| Children | ||
| • Indicated: patient/caregiver education [26,28]; inform patient/caregiver that excess weight is associated with GERD symptoms [28] | ||
| • Not indicated: prebiotics, probiotics, or herbal medication [28] | ||
| Pharmacological treatment of GERD | • Indicated: proton pump inhibitors (PPIs, first-line), H2 antihistamines (H2RAs, second-line) [28], or select between PPIs and H2RAs based on practicality [26] | |
| • Not indicated: any medication for otherwise healthy patients with isolated overt regurgitation; metoclopramide, domperidone, or erythromycin [26,28] | ||
| Surgical treatment of GERD | Consider anti-reflux surgery such as fundification in infants or children: | |
| • Only if other conditions have been ruled out [28] | ||
| • If symptoms are refractory to lifestyle changes and medication [26,28] | ||
| • If there is a need for chronic pharmacotherapy [28] | ||
| • In cases where a chronic condition places patient at serious risk for a GERD-related complication [28] | ||
| Refractory GERD in primary-care settings | Referral to pediatric gastroenterologist [26,28] | |
GER: gastroesophageal reflux, GERD: gastroesophageal reflux disease.