Avoiding overprescribing medications for infant GERD

Distinguishing between gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in infants is critical to providing appropriate treatment and avoiding overclassifying infants with GERD that leads to overtesting and overtreatment. Pediatricians need to learn how to recognize infants with “simple GER in whom conservative recommendations are more appropriate, and identifying infants with GERD in whom more diagnostic evaluation and treatment is appropriate,” according to David A. Gremse, MD, professor and chair of pediatrics, University of South Alabama, Mobile.

Gremse discussed indications for acid suppression in infants with an emphasis on the importance of distinguishing GER from GERD and walked participants through various treatment strategies based on different clinical situations in a session on Saturday, October 11, titled “To treat or not to treat? Avoiding the overprescription of medications for infant GERD.”

Highlighted in his presentation was the need to avoid overtesting and overtreatment of GERD. Most patients with GERD, he explained, can be treated by primary care providers without the need for testing. Indications for referral to a gastroenterologist or for further testing include patients who do not respond to therapy with proton pump inhibitors; those with significant side effects to or unable to be weaned from medical therapy; or patients with signs of complications or severe disease.

Key to avoiding overprescribing drugs for infant GERD, Gremse commented, is for pediatricians to recognize conditions in infants who have symptoms that mimic GERD, such as an allergy to cow’s milk, for which acid suppression therapy will be ineffective. For example, projectile vomiting may occur in infants with milk protein intolerance associated with delayed gastric emptying.

He stressed that for many infants with GERD their symptoms will improve without medications by implementing appropriate lifestyle modifications, such as placing the infant in an upright position when awake and not feeding the infant prior to riding in an infant car seat.

Of particular importance is for pediatricians to prescribe a 2-week trial of changing to a hypoallergenic formula for infants with vomiting and poor weight gain before prescribing acid suppression therapy.

Finally, Gremse said to consider disorders other than GERD if symptoms begin in infants and toddlers after the age of 6 months.