Too many GERD diagnoses in those too young?

A new study raises a question about whether too many antireflux procedures (ARP) are performed on children during a period of infancy when frequent regurgitation is normal and when already ambiguous measures of gastroesophageal reflux disease (GERD) are difficult to interpret at best.

According to the investigators, although GERD is a common diagnosis in infants and young children, “no objective criteria exist to guide the diagnosis and treatment of this disease” in these populations.

Researchers from Seattle and New Orleans conducted a retrospective cohort study using inpatient data from 41 US children’s hospitals. To be included, the children had to be younger than 18 years of age and discharged between 2002 and 2010 with a diagnosis of GERD.

The investigators found that of the nearly 150,000 children included in the research, a little over 8% underwent an ARP during the study period, with half of those undergoing the procedure when aged 6 months or younger. Although almost two-thirds of those in the ARP group received preoperative upper gastrointestinal tract fluoroscopy, all of them did not receive a uniform workup.

Performance of an ARP was significantly less likely in those aged 7 months to 4 years and in those aged 5 to 17 years than in those aged younger than 2 months and those 2 to 6 months of age. ARP procedures were much more likely in those who also had failure to thrive, neurodevelopmental delay, cardiopulmonary anomalies, cerebral palsy, or aspiration pneumonia, and in those with tracheoesophageal fistula or diaphragmatic hernia.

The American Academy of Pediatrics recently issued guidelines emphasizing that not all cases of gastroesophageal reflux are gastroesophageal reflux disease, and that all opportunities to correct symptoms with lifestyle changes should be exhausted before attempting more intensive or invasive strategies.

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