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Update on drugs for gastro-oesophageal reflux disease
  1. Simon Keady
  1. For correspondence:
    MrS Keady
    University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; simon.keady{at}uclh.nhs.uk

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Gastro-oesophageal reflux (GOR) is a common and usually self-limiting condition involving the regurgitation of gastric contents into the oesophagus. It causes symptoms (table 1) such as heartburn, oesophagitis, acute life-threatening events and respiratory disease,1–3 at which point it is defined as gastro-oesophageal reflux disease (GORD).

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Table 1

 Symptoms of gastro-oesophageal reflux disease (GORD)

The prevalence of GOR and GORD in infants is between 20–40%, higher than that in children and adults. This high number is associated with the transient immaturity of the oesophagus and the stomach. Features include a short abdominal oesophagus (<1 cm), increased oesophageal clearance, increased number of transient lower oesophageal sphincter relaxations coupled with delayed gastric emptying.4–6

Methods of detection include oesophageal pH monitoring, especially with respiratory manifestations,1,3,7–9 or multiple intraluminal impedance.10–12 The latter allows detection of continued postprandial reflux despite a neutralisation of gastric contents by milk formula.

However, there continues to be a wide variation in diagnostic and management strategies even across major neonatal intensive care units in the UK, requiring further work to evaluate appropriateness and effectiveness.13

TREATMENT OF GOR AND GORD IN INFANTS, CHILDREN AND YOUNG PEOPLE

The principal aims of treatment are to alleviate symptoms, allow healing of the oesophageal mucosa if indicated, manage and prevent any complications and to maintain long-term remission.

Treatment strategies and options depend upon the severity of the GORD and may include lifestyle changes or pharmacological and surgical interventions. Older children and young people should be counselled on specific lifestyle changes such as weight reduction if obese and the avoidance of smoking and drinking alcohol if necessary.

For the purpose of this article, the focus will primarily be on drug management of this condition (table 2).

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Table 2

 Summary of drugs used to treat GOR and GORD

TREATMENT OF GOR OR MILD GORD

Normal steps in the management of mild conditions are usually non-pharmacological and may involve …

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