What is the role of drug therapy in the treatment of pediatric gastroesophageal reflux disease (GERD)?

Updated: Mar 14, 2019
  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD  more...
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Guidelines from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) discuss the use of step-up and step-down therapies, which should be instituted under the guidance of a pediatric gastroenterologist. [15, 16]

In the case of pharmacologic intervention, step-up therapy involves progression from diet and lifestyle changes to H2 -receptor blockade medications (eg, ranitidine, nizatidine) to proton pump inhibitors (eg, omeprazole, lansoprazole). [17] Both classes of acid antisecretory agents have proven safe and effective for infants and children in reducing gastric acid output.

The proton-pump inhibitor rabeprazole sodium is now approved by the US Food and Drug Administration (FDA) for the treatment of GERD in pediatric patients aged 1-11 years. [18, 19] This agent was already indicated for (1) treatment of adults with GERD and duodenal ulcers, (2) eradication of Helicobacter pylori in adults, and (3) short-term treatment of symptomatic gastroesophageal reflux in adolescents (≥12 years).

In combination with diet and lifestyle changes, this management guideline should render surgery unnecessary in the vast majority of cases. One important exception, however, may be children with moderate to severe neurodevelopmental disabilities who typically manifest both dysphagia and GERD and are at high risk for aspiration. In these patients, conservative therapy alone may not be sufficient for preventing reflux-associated complications. However, careful monitoring under optimal nonsurgical therapy should be conducted before operative intervention is considered.

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