Pediatric GERD

Question 1

Gastroesophageal reflux

Answer 1

Common in infancy and resolves by 12-14 years of age.
Up to 2/3 of infants experience recurrent regurgitation and vomiting within the first 4 months of life, only 5% have reflux beyond 1 year of age

Question 2

Gastroesophageal reflux disease

Answer 2

Troublesome clinical symptoms and/or complications associated with the passage of stomach contents into the esophagus

Complications include reflux esophagitis, delayed gastric emptying, decreased LES pressure, immature peristalsis

Question 3

Treatment of GER

Answer 3

Parental reassurance, positional changes (supine for sleeping), changing volume/frequency of feeding, trying a hypoallergenic or anti-reflux formula, and thickening the formula to increase caloric density

Question 4

H2RAs in GERD

Answer 4

Quick onset, data in pediatrics, cost-effective, no need to taper upon DC, liquid formulations available.
Maintenance for mild GERD, use prn

Question 5

PPIs in GERD

Answer 5

Most potent, no meal-induced acid secretions, heals esophagitis > H2RAs
Limited liquid formulations, CYP genetic polymorphisms, ADEs, Cost, Increased infections, rebound
Maintenance for GERd and erosive esophagitis

Question 6

Prokinetic agents in GERD

Answer 6

Significant adverse effects
May be useful in delayed gastric emptying
Not routinely used

Question 7

Antacids

Answer 7

Quick onset, variety of dosage forms, low risk of adverse events.
Require frequent admin, efficacy &laquo_space;H2RA, PPI
Use PRN

Question 8

Surface agents

Answer 8

Coat may heal mucosa, low risk of adverse events
Adjunctive use to H2RA, PPI in erosive esophagitis

Question 9

PK challenges with PPIs

Answer 9

Children 1-10 years of age require higher mg/kg dose
PPIs metabolized by 2C19 and 3A4
Activity of 2C19 varies with age, low at birth, adult values at 6-12 months, > adult values between 1-4 years, then decreases back to adult levels around puberty

Treat for 12 weeks, then taper over 4 weeks