Gastro-oesophageal refl ux in infants: optimizing behavioural and pharmacological therapy

Abstract

The aim was to investigate the prevalence of gastro-oesophageal refl ux (GOR) in newborns and unweaneds because of its possible overestimation or underestimation due to parent’s disposition. The main purposes of this study were to evaluate the eff ectiveness of behavioural therapy to limit the use of drug, and the correlation between GOR and type of feeding, since there is evidence in the literature that breastfeeding could have a protective role. This prospective observational study was carried out in paediatric patients from June 2015 to December 2017. We enrolled 180 children aged between one and six months. Patients were classifi ed in two groups, as follows: group 1 (without GOR) and group 2 (with GOR). Inclusion criteria in group 2 were the presence of at least one of the following symptoms: early sense of satiety, nausea, aversion to food, vomiting and/or regurgitation, rumination, poor growth, wheezing, and cry. History exploration and clinical investigation were conducted to analyse the main characteristics of refl ux episodes and the possible correlation with breastfeeding. Behavioural treatment based on postural measures and dietary advice was prescribed to group 2 infants. In case of non-response to therapy, histamine H2 receptor antagonists (H2RAs) were prescribed at a dosage of 5 mg/kg/day in two doses. The presence of GOR was excluded in 140/180 (77.8%) children, yielding a refl ux prevalence index equal to 22.2% of the sample (40/180). Regarding the symptoms, 95% of the group with refl ux showed vomiting, regurgitation, rumination and poor growth; 2.5% also showed wheezing, and the remaining 2.5% showed inconsolable crying too. No statistically signifi cant correlation was found between the type of feeding and the onset of refl ux. In group 2 (with GOR), 97.5% of the infants responded to behavioural therapy, while the condition failed to improve in only 2.5% and drug therapy with H2RAs was started. GOR is a common clinical condition in infants. Conservative approach is more required in children than in adults, especially considering both regression of GOR within the fi rst year of life in most cases and side eff ects of pharmacological treatment. Breastfeeding did not appear to have a signifi cant role. Key words: CHILD; GASTROESOPHAGEAL REFLUX; BREAST FEEDING; THERAPY