GERD 101
One represents a normal, physiologic reflux in infants and the other a pathologic condition with troublesome symptoms
What is GER and GERD
This med (bonus points for its class) was given off-label at 0.75 mg/kg/dose twice daily for GERD
What is omeprazole (a PPI)?
Infants admitted with clinical symptoms of GERD between 34 and 60 weeks’ age, an intake volume of full enteral feeds ≥150 mL/kg/day, room air or supplemental oxygen ≤1 L per minute, and ARI ≥ 3%
What are the study inclusion criteria?
This is the major mechanism behind both acid and nonacid reflux in infants.
transient lower esophageal sphincter relaxation
Prior studies using this kind of criteria to start acid suppression showed a lack of benefit on symptom improvement.
What are symptom-based criteria?
The primary outcome was independent oral feeding and/or a decrease of at least this many points on the I-GERQ-R symptom score
What is six?
This pH derived measure represents the percentage of time the esophagus is exposed to acid, and is used to objectively define acid-GERD
Acid Reflux Index (ARI)
>7% considered severe and 3-7% indeterminate.
Feeding in the right lateral position, Limiting fluid intake to under 140 mL/kg/day, supine postprandial position
What are behavioral/feeding strategy modifications?
Primary outcome success was 33% in the bundle arm versus 44% in the conventional arm (P=0.28) thus this was the verdict on whether the bundle was superior.
What is "not superior" (not significant)?
Of the 688 screened infants with GERD-type symptoms, this percentage (246 infants) had a normal ARI (<3%)
What is 36%?
Aka the proportion of symptomatic infants with no abnormal acid exposure
This survey measures parental/provider perception of symptom burden thought to be due to GERD
The infant GER questionnaire-revised (I-GERQ-R)
GERQ-R scores fell significantly in both arms. The authors suggested this developmental process, not the bundle, as the likely explanation
What is maturation?