G364(P) Management of gastroesophageal reflux in infants: current practice of diagnosis and treatment in a uk district general hospital

Abstract

Objectives and study According to current ESPGHAN and NASPGHAN guidelines, gastroesophageal reflux (GER) is defined as the passage of gastric contents into the oesophagus with or without regurgitation and vomiting. GER is considered to be physiological in the majority of young infants under the age of 12 months. Typically, episodes of GER in healthy individuals last <3 min, occur in the postprandial period, and cause few or no symptoms. In contrast, gastroesophageal reflux disease (GERD) is present when the reflux of gastric contents causes troublesome symptoms and/or complications such as faltering growth, recurrent pneumonias, apnoea, dystonic head posturing. Limited data is currently available on the adherence of healthcare professionals to existing guidelines in daily practice, however some reports highlight the risk of over-diagnosing GERD and the inadequate use of treatments, such as acid suppression. Aim of the study The aim of this study was to assess current clinical practice and adherence to ESPGHAN guidelines regarding the diagnosis and management of infants presenting with symptoms of GER/GERD. Methods Medical records of 60 patients treated in an inpatient or outpatient setting, age 1 day to 1 year and with a diagnosis of GOR or GORD were randomly collected. Data recorded for each patient included: specific diagnosis, presence of clinical symptoms suggestive of GOR/GORD, choice of treatment and if the diagnostic criteria according to ESPGHAN guidelines were met. Results In total 100% of patients included in this study were diagnosed with GOR, rather than GORD despite the presence of what could be considered as “troublesome symptoms”. The two most frequently reported symptoms were poor weight gain n = 6 (10%) and irritability n = 40 (66%). Importantly, despite being “officially” diagnosed with GOR, 55 out of 60 children (91%) were commenced on anti-reflux medication (i.e. proton pump inhibitors or the H2 receptor blocker Ranitidine). All parents were provided with education and guidance. Conclusion Our small study provides insight into current clinical practice in a district general hospital and highlights major insufficiency in the understanding and management of GOR/GORD. Despite diagnosing GOR the majority of infants are commenced on medical treatment. Active advice and teaching to healthcare professionals in the primary and secondary sector is required to improve the situation in the long term.