European Pediatricians' Approach to Children With GER Symptoms

Quitadamo, Paolo; Papadopoulou, Alexandra; Wenzl, Tobias G.; Urbonas, Vaidotas; Kneepkens, C. M. F.; Román, Enriqueta; Orel, Rok; Pavkov, D.; Dias, Jorge Amil; Vandenplas, Yvan; Kostovski, Aco; Miele, Erasmo; Villani, Alberto; Staiano, Annamaria

doi:10.1097/mpg.0b013e3182a69912

Cited by 60 publications

(26 citation statements)

References 26 publications

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“…The lack of awareness of guidelines on CMPA and the training identified as necessary on this topic has bearing on the recognition and management of this food allergy ( Table 3 ). Our data is supported by a larger study by Hazeldine et al [ 27 ] on GPs’ perceptions of UK allergy care. More than 50% rated allergy care in primary care as poor and 40% reported that they would benefit from more training.…”

Section: Discussionsupporting

confidence: 88%

“…Although it may be perceived as a problem unique to the UK as GPs are the first point of contact for the recognition of CMPA, data implies that there are similar knowledge barriers for paediatricians worldwide. Quitadamo et al published in 2014 a result from a survey that evaluated the knowledge about gastro-oesophageal reflux guidelines and found that the majority of the paediatricians were unaware of the 2009 guideline from ESPGHAN and the North American Society for Pediatric, Gastroenterology, Hepatology and Nutrition [ 27 ]. In 2014, Maslin et al [ 28 ] published a survey on food allergy competencies amongst UK, Australian and USA dietitians, and found a similar trend in physicians with a need to increase their knowledge in different aspects of food allergy diagnosis and management, specifically the areas of developing food challenge protocols and management of feeding problems.…”

Section: Discussionmentioning

confidence: 99%

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Cow’s Milk Protein Allergy from Diagnosis to Management: A Very Different Journey for General Practitioners and Parents

et al. 2015

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Cow’s milk protein allergy (CMPA) is the most common food allergy in infants and can affect a family’s quality of life. The purpose of this paper is to evaluate the knowledge and experience of general practitioners (GPs) in terms of CMPA diagnosis and management and to explore the views of parents on the current diagnostic process. Two surveys were conducted in June 2014, which collected data from GPs and parents of infants diagnosed with CMPA in the United Kingdom. The questionnaires included quantitative and qualitative questions, which measured self-reported knowledge, management and perceived treatment progression, and the educational needs of GPs. We also explored parents’ experiences of local healthcare support in relation to CMPA. A total of 403 GPs and 300 parents completed the surveys. The main symptoms of CMPA and diagnosis period differed between GPs and parents. Other key points include different perceptions on symptom presentation and improvement, lack of awareness from GPs about current guidelines, and the significant burden on both families and GPs. This is the first study attempting to establish GP and parental experience in diagnosing CMPA. It isnotable that the difference can be improved through training, appropriate diagnostic tools and improved communication between physicians and parents.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Cow’s Milk Protein Allergy from Diagnosis to Management: A Very Different Journey for General Practitioners and Parents

et al. 2015

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“…In infants with troublesome symptoms of GER, when a conservative approach has failed, an alginate-based formulation should be preferred to acid inhibitors. These acid inhibitors continue to be over-prescribed despite their cost, the very limited clinical evidence of reducing GER symptoms in this age group, and the possible adverse effects [29].…”

Section: Discussionmentioning

confidence: 99%

Magnesium Alginate in Gastro-Esophageal Reflux: A Randomized Multicenter Cross-Over Study in Infants

Martire

Mauro

Pignatelli

et al. 2019

IJERPH

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The aims of this study were to evaluate the efficacy of magnesium alginate in decreasing functional regurgitation symptoms in infants, and to assess the cost–benefit ratio of magnesium alginate compared to a thickened formula. A multicenter perspective cross-over study was conducted in formula-fed infants with persisting regurgitation, randomly assigned to receive two weeks of a magnesium-alginate-based formulation followed by two weeks of thickened formula, or vice-versa. Infants, exclusively breast-fed, were followed up for two weeks while receiving magnesium alginate. Symptoms of gastroesophageal reflux (GER) were evaluated through the Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R). Direct cost of treatments was also calculated. Seventy-two infants completed the study. We found a significant reduction of I-GERQ-R scores over time (F = 55.387; p < 0.001) in all groups with no difference between the sequences of administration (F = 0.268; p = 0.848) in formula-fed infants and between exclusively breast-fed and formula-fed infants receiving magnesium alginate (t = 1.55; p = 0.126). The mean cost savings per infant was € 4.60 (±11.2) in formula-fed infants treated with magnesium alginate compared to thickened formula (t = 2.91, p < 0.0005). Conclusions were that the magnesium-alginate formulation reduces GER symptoms both in formula-fed and breast-fed infants. In formula-fed infants, clinical efficacy is similar to thickened formulas with a slightly lower cost of treatment.

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“…Overall, it has been widely recommended that GAI treatment in infants should be reserved for cases with evidence of pathological exposure to acid reflux episodes and/or oesophagitis[1]. Despite these recommendations, studies have found very poor adherence to guidelines and significant overtreatment with PPIs[15]. There is a concerning increase in the use of pharmacological intervention using acid suppression therapy using PPIs and H2RAs in preterm infants, with a presumed diagnosis of GORD based on symptoms alone in the absence of any objective measures for the diagnosis of GORD including pH and impedance monitoring or gastroscopy and biopsy[5].…”

Section: Gastric Acid Inhibitor Use In Infantsmentioning

confidence: 99%

Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?

Safe¹,

Chan²,

Leach³

et al. 2016

WJGPT

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Gastroesophageal reflux is a common phenomenon in infants, but the differentiation between gastroesophageal reflux and gastroesophageal reflux disease can be difficult. Symptoms are non-specific and there is increasing evidence that the majority of symptoms may not be acid-related. Despite this, gastric acid inhibitors such as proton pump inhibitors are widely and increasingly used, often without objective evidence or investigations to guide treatment. Several studies have shown that these medications are ineffective at treating symptoms associated with reflux in the absence of endoscopically proven oesophagitis. With a lack of evidence for efficacy, attention is now being turned to the potential risks of gastric acid suppression. Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections, bacterial overgrowth, adverse bone health, food allergy and drug interactions.

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European Pediatricians' Approach to Children With GER Symptoms

Cited by 60 publications

References 26 publications

Cow’s Milk Protein Allergy from Diagnosis to Management: A Very Different Journey for General Practitioners and Parents

Cow’s Milk Protein Allergy from Diagnosis to Management: A Very Different Journey for General Practitioners and Parents

Magnesium Alginate in Gastro-Esophageal Reflux: A Randomized Multicenter Cross-Over Study in Infants

Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?

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