Antireflux drugs often given to infants without GERD

An evaluation of infants with persistent regurgitation who were referred to a pediatric gastroenterology service showed that most infants who were prescribed antireflux drugs before referral did not meet diagnostic criteria for gastroesophageal reflux disease (GERD). Of 64 infants who had been evaluated for symptoms of regurgitation lasting more than two weeks, more than 90% had been given antireflux medication.

Thickening of feeds also was a common intervention before referral. Yet diagnostic tests indicated that only eight of the 64 infants had GERD, based on abnormal esophageal pH with or without impedance studies.

Investigators performed extended esophageal pH/impedance monitoring studies on 44 of the infants, 42 of whom already were on antireflux medications. Only eight of these 44 (18%) had abnormal studies. Of the remaining 20 infants who did not get a pH/impedance study, four had pyloric stenosis and one had renal tubular acidosis. The remaining 15 infants were thriving and had only regurgitation without accompanying symptoms.

Commentary:
The authors suggest that regurgitation in the absence of significant reflux disease should be managed conservatively, without medications. They consider raising the stakes only in the face of poor weight gain, persistent crying and irritability, feeding problems, recurrent respiratory symptoms, hoarseness, hematemesis, or persistently disturbed sleep. Using these criteria, most spitting infants could be kept off antireflux medications, saving money and avoiding potential medication side effects. This seems like good advice to me.