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Paediatric gastroesophageal reflux clinical practice guidelines
  1. Nkem Onyeador,
  2. Siba Prosad Paul,
  3. Bhupinder Kaur Sandhu
  1. Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK
  1. Correspondence to Dr Siba Prosad Paul, Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK; siba.paul{at}nhs.net

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Information about current guidelines

Gastroesophageal reflux (GOR) symptoms in infants are a common reason for consulting medical professionals, with a reported prevalence of 4.3% at 6 months which decreases to 2% by 18 months of age.1

In May 2009, the North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) jointly published clinical practice guidelines on the diagnosis and management of GOR in children.2 The aim was to develop ‘an international consensus on the diagnosis and management of GOR and GOR disease (GORD) in the paediatric population’.2 A recent clinical report from the American Academy of Pediatrics has re-endorsed these guidelines.3 Consensus statements have been developed by an international panel of nine paediatric gastroenterologists and two epidemiologists based on the Delphi principle and included analysis of >600 articles.2 The guidelines are aimed at paediatricians and paediatric subspecialists for use in daily practice.

Previous guidelines

In 1997, consensus-based guidelines on several aspects of GOR and GORD were developed by the ESPGHAN Working Group on GOR.4 In 2001, NASPGHAN published its first clinical practice guidelines on paediatric GOR and GORD, and this document served as the basic structure for the recent guidelines5 (see box 1).

Box 1

Resources

  • NSPGHAN/ESPGHAN (2009) guidelines

    http://www.naspghan.org/user-assets/Documents/pdf/PositionPapers/FINAL%20-%20JPGN%20GERD%20guideline.pdf

  • American Academy of Pediatrics Clinical Report 2013

    http://pediatrics.aappublications.org/content/131/5/e1684.long

  • National Institute of Health and Care Excellence (NICE) Clinical Knowledge Summaries on Gastroesophageal reflux disease in children (Last revised in December 2009)

    http://cks.nice.org.uk/gord-in-children#!topicsummary

Controversial and key issues that the GUIDELINES ADDRESS

Definition of GOR and GORD

The guidelines have emphasised the difference between the terms GOR and GORD, which are to be strictly used as defined. GOR is the effortless passage of gastric contents into the oesophagus with or without regurgitation and vomiting, and is a normal physiological process. GORD occurs when the reflux of gastric contents causes troublesome symptoms and/or complications.

Diagnosis

In …

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