Is Infant GERD Over-Diagnosed?

Document Sample
Is Infant GERD Over-Diagnosed? Powered By Docstoc
					Is Infant GERD Over-Diagnosed?
                                                                                               By Vikki Sloviter

Is it me, or does it seem that ev-      that pediatricians may be overpre-      shouldn’t have been on anti-reflux
ery other infant I know has, or         scribing anti-reflux medications        medications. Their study found that
has had, GERD—gastroesophageal          because they think they’re treating     only 20% of the infants had an “un-
reflux disease—that yucky and           a patient’s GERD when that patient      derlying pathology”—GERD, pyloric
annoying condition where a child        really may just have GER. Vikram        stenosis or renal tubular acidosis—
can’t keep down food or liquids         Khoshoo, MD, PhD, and his col-          to explain their symptoms.
and regurgitates almost everything      leagues at the Pediatric Specialty
she ingests? Its prevalence seems       Center of West Jefferson Medical        Interestingly, when the researchers
almost that of asthma, another          Center in New Orleans, Louisiana,       took into account how parents fed
widespread condition that seems to      evaluated the medical records of        their child (e.g. formula changes,
affect half the pediatric population    64 infants who, over a three-year       thickness of formula, amount fed),
these days. A week doesn’t go by        period, had presented to a pediat-      they believed that many of the
when I haven’t heard a parent tell      ric gastroenterology practice with      infants’ symptoms could be more
me that her child was on Prevacid       persistent regurgitation and were       easily explained, and not attributed
or some other anti-acid medica-         suspected of having GERD.               to GERD. In particular, in some cas-
tion to battle infant GERD. So the                                              es, infants’ medical histories had
seemingly high incidence of GERD        The diagnostic workup revealed          indicated that parents had been
prompts parents and medical pro-        that 37 (57.8%) of the 64 infants       under-thickening their infant’s for-
fessionals alike to ask, are there      presented with only regurgitation,      mula. Though parents were advised
actually more cases of GERD today       10 (15.6%) presented with regur-        to thicken the formula, they were
than there were years ago, or is        gitation and irritability, 10 (15.6%)   not advised to reduce the amount
GERD simply over-diagnosed and          presented with regurgitation and        of formula. The researchers noted
often mistaken for reflux?              feeding problems, and seven             that this overfeeding could result
                                        (10.9%) presented with regurgi-         in gastric distention, which in turn
Parents often confuse GER and           tation and respiratory problems.        could precipitate the conditions
GERD. The former, gastroesopha-         Fifty-eight (90.6%) of the infants      that cause reflux. In short, some
geal reflux, is just that: reflux,      were on anti-GERD medications.          infants were being overfed, which
when stomach contents back up                                                   was causing them to reflux but was
into the esophagus and sometimes        Diagnostic tests further revealed       not causing GERD.
come out the mouth as spit up or        that 13 (20.3%) of the 64 infants
vomit. Reflux is common in infants,     had abnormal results. Of these 13,      The researchers also found it
and up to 50% of infants up to          eight infants had abnormal esopha-      interesting that the infants that
three months of age may experi-         geal pH (GERD), four infants had        presented with only regurgitation
ence normal GER. By age 12-24           hypertrophic pyloric stenosis, four     tended to have normal esophageal
months, most infants outgrow it.        infants had metabolic alkalosis, and    pH-probe results, whereas infants
Reflux becom
Description: [...] some infants were being overfed, which was causing them to reflux but was not causing GERD.
ProQuest creates specialized information resources and technologies that propel successful research, discovery, and lifelong learning.