Diagnosis and Management of Gastroesophageal Reflux Disease (GERD): An Indian Perspective.
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Date
2013-01
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Abstract
Need and Purpose: The scarcity of literature and lack of published guidelines on gastroesophageal reflux disease (GERD) from India,
have necessitated this review.
Methods: A literature search in PubMed was conducted with regard to epidemiology, clinical features, investigation and management
of GERD in children. English language studies published full over the last 20 years were considered and relevant information was
extracted.
Results: Nearly half of all healthy babies regurgitate at least once a day by 4 months of age and this subsides in 90% of them by 1 year.
In contrast, GERD prevalence increases with age and by adolescence it is similar to adults (20%). While regurgitation in infancy does
not need investigation or therapy, ‘empirical’ proton pump inhibitor (PPI) for 4 weeks is justified in older children with classical GERD
symptoms. There is no gold-standard investigation for GERD. A pH study with or without impedance is useful in extraesophageal
manifestations and endoscopy in esophagitis. Proton pump inhibitors (PPI) play a pivotal role in the management of GERD and its
long-term use has been shown to be safe in children. Antireflux surgery plays a minor role due to, its associated morbidity and high
failure rate, especially in the high risk group who needs it most.
Conclusions: Regurgitation in infancy need not be investigated unless there are warning features. Empirical PPI therapy is justified in
older children and adolescents with typical reflux symptoms. pH study in extraesophageal manifestations and endoscopy for
esophagitis are the investigations of choice. PPI is the mainstay of therapy in GERD.
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Keywords
Endoscopy, Impedance, pH study, Proton pump inhibitors, Regurgitation
Citation
Poddar Ujjal. Diagnosis and Management of Gastroesophageal Reflux Disease (GERD): An Indian Perspective. Indian Pediatrics. 2013 January; 50(1): 119-126.