Diagnosis and management of food allergy‐associated gastroesophageal reflux disease in young children—<scp>EAACI</scp> position paper

Vandenplas, Yvan; Lozinsky, Adriana Chebar; Vieira, Mário César; Canani, R. Berni; Dupont, Christophe; Uysal, Pınar; Cavkaytar, Özlem; Knibb, Rebecca; Fleischer, David M.; Nowak‐Węgrzyn, Anna; Venter, Carina

doi:10.1111/pai.13856

Cited by 11 publications

(10 citation statements)

References 117 publications

(293 reference statements)

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“…International guidelines suggest that CMA should be excluded prior to prescribing PPIs. 37,38 In the community dietetic service 39% of the patients were prescribed a PPI prior to diagnosis compared with only 13% in the dietetic-led service where it is actively discouraged, falling to 10% in both services after cow's milk exclusion.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of reflux or vomiting can lead to over‐prescription of proton pump inhibitors (PPI), which are not thought to be effective in this age group, could have side effects, 34–36 and increase prescribing costs. International guidelines suggest that CMA should be excluded prior to prescribing PPIs 37,38 . In the community dietetic service 39% of the patients were prescribed a PPI prior to diagnosis compared with only 13% in the dietetic‐led service where it is actively discouraged, falling to 10% in both services after cow's milk exclusion.…”

Section: Discussionmentioning

confidence: 99%

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Impact of a dietitian in general practice: paediatric food allergy

Collinson

Waddell

Hickson

2023

J Human Nutrition Diet

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Background: Food allergy in infants and young children places a significant burden on primary care. This study evaluated a dietetic-led paediatric food allergy service, which attempts to provide more rapid access to the dietitian and reduce the need for general practitioner (GP) and secondary care appointments. Methods: Two community dietetic services for children referred with food allergy were compared. The first was dietetic-led care where dietitians train community children's nurses to recognise potential cases of food allergy, undertake basic diagnostic assessment and subsequently refer to the dietitian. The other was a more traditional dietetic community service where patients were referred predominantly by the GP or secondary care. Results: In dietetic-led care 86 patients were seen, compared to 96 in dietetic community care. Dietetic-led care received fewer referrals from the GP, 36% versus 67% ( p < 0.001); GP appointments for allergy-related conditions prior to dietetic referral were lower, 3 versus 6 visits ( p = 0.001); and input from secondary care was also lower, 8 versus 25 patients ( p = 0.002) compared with dietetic community care. Children referred to dietetic-led care were younger, 78% <6 months versus 40% ( p < 0.001) in dietetic community care. Conclusions: Dietetic-led care describes a model that has the potential to reduce GP and secondary care appointments, identify patients more quickly and reduce the time to receive dietetic input, thereby resolving symptoms more quickly and reducing prescribed medications. This model demonstrates the importance of integrated care and multidisciplinary working, offering a solution to reducing GP workload while maintaining or improving patient care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of a dietitian in general practice: paediatric food allergy

Collinson

Waddell

Hickson

2023

J Human Nutrition Diet

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“…Moreover, to date, there have been no international guidelines about the cutoff for the P-LPR diagnostic with HEMII-pH. The future determination of P-LPR incidence and prevalence should consider the age of children/infants because as with GERD, P-LPR is expected to be more prevalent during the first 12 months of life according to the immaturity of esophageal sphincters [ 22 ].…”

Section: Epidemiologymentioning

confidence: 99%

Pediatric Laryngopharyngeal Reflux: An Evidence-Based Review

Lechien

2023

Children

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Purpose: Pediatric laryngopharyngeal reflux (P-LPR) is associated with the development of common otolaryngological symptoms and findings. In the present study, the findings about epidemiology, clinical presentation, diagnostic and therapeutic outcomes of pediatric population were reviewed. Methods: A PubMed, Cochrane Library, and Scopus literature search was conducted about evidence-based findings in epidemiology, clinical presentation, diagnostic and therapeutic outcomes of P-LPR. Findings: The prevalence of LPR remains unknown in infant and child populations. The clinical presentation depends on age. Infants with LPR symptoms commonly have both gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux and related digestive, respiratory and ear, nose and throat symptoms. The GERD prevalence appears to decrease over the growth, and the clinical picture is increasingly associated with LPR symptoms and findings without GERD. The prevalence of LPR and proximal acid and nonacid esophageal reflux events may be high in some prevalent otolaryngological conditions (chronic otitis media, laryngolomalacia and apnea). However, the lack of use of hypopharyngeal–esophageal multichannel intraluminal impedance pH monitoring (HEMII-pH) limits the establishment of etiological associations. Proton pump inhibitors are less effective in P-LPR patients compared to GERD populations, which may be related to the high prevalence of weakly or nonacid reflux events. Conclusions: Many gray areas persist in P-LPR and should be not resolved without the establishment of diagnostic criteria (guidelines) based on HEMII-pH. The unavailability of HEMII-pH and the poor acid-suppressive therapeutic response are all issues requiring future investigations. Future controlled studies using HEMII-pH and enzyme measurements in ear, nose or throat fluids may clarify the epidemiology of P-LPR according to age and its association with many otolaryngological conditions.

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“…The disease could occur in 25.5% of babies aged 0–1 month, decreasing to 1.1–1.6% by 1 year of age [ 3 , 5 ] and ranging from 0.9% to 18.8% [ 5 , 6 ] in childhood and adolescence. Higher rates of GERD are seen in children with a history of prematurity [ 7 , 8 ], developmental and neuromuscular disorders [ 9 ], a cow’s milk protein allergy [ 3 , 10 , 11 , 12 ], or pulmonary disease [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Proton Pump Inhibitors in Pediatric Gastroesophageal Reflux Disease: A Systematic Review of Randomized Controlled Trials

Fernández-González,

Moreno-Álvarez,

Solar-Boga

2024

Children

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This systematic review was conducted with the objective of understanding the efficacy and safety of proton pump inhibitors (PPIs) in the pediatric population. We used PubMed to identify randomized controlled trials (RCTs) published between 1 June 2010 and 30 June 2023, performed in patients from birth to 18 years old with gastroesophageal reflux disease (GERD) who received treatment with any PPI. This literature search yielded 76 articles and 13 of these met the inclusion criteria. For infants, PPIs were equal to placebos in reducing GERD symptoms in four articles. In one article, the numbers of GER episodes and esophageal acid exposures were lower in infants who received PPIs in the left lateral position, but there was generally no significant improvement in symptoms. In another publication, the combination of PPIs and feeding modifications (FMs) was not more effective than PPIs alone. For children and adolescents, PPIs were effective in improving symptoms and achieving endoscopic healing, which was subsequently maintained. To conclude, PPIs are not effective in reducing the symptoms related to GERD in infants but are effective in older children, where histological remission can be seen. Generally, PPIs are well tolerated, but it is important to remember the possible adverse events (AEs), especially if PPIs are used for an extended period.

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Diagnosis and management of food allergy‐associated gastroesophageal reflux disease in young children—EAACI position paper

Cited by 11 publications

References 117 publications

Impact of a dietitian in general practice: paediatric food allergy

Impact of a dietitian in general practice: paediatric food allergy

Pediatric Laryngopharyngeal Reflux: An Evidence-Based Review

Proton Pump Inhibitors in Pediatric Gastroesophageal Reflux Disease: A Systematic Review of Randomized Controlled Trials

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