The New England Journal of MedicineMedication for Gastroesophageal Reflux Disease in Infants

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This article discusses the management of gastroesophageal reflux disease (GERD) in infants, presenting a case of a 3-month-old with persistent symptoms despite conservative measures. It outlines the prevalence of reflux in infants, distinguishes between normal reflux and GERD, and considers the use of medication in treatment-resistant cases.

Key Points:

• Gastroesophageal reflux affects approximately 50% of infants aged 3-4 months, decreasing to about 5% by 1 year.
• GERD is diagnosed when reflux leads to troublesome symptoms or complications affecting daily functioning.
• Initial management includes positional changes, frequent burping, and dietary modifications.
• For persistent cases, a short trial of medication may be considered, following guidelines from pediatric gastroenterology societies.
• Proton pump inhibitors (PPIs) or histamine2-receptor antagonists can be used to suppress gastric acid production.
• A 4-week trial of omeprazole is recommended, with careful monitoring and gradual weaning if effective.
• Potential adverse effects of PPIs include respiratory infections and C. difficile infection, which must be weighed against benefits.

In a study from 2019, researchers found that infants who were given a PPI before age 1 were 23% more likely to have a bone fracture during childhood, and those prescribed a PPI and H2RA were 31% more likely. (AJMC)

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