Several pointers from this bowel sounds episode:
- For thickeners, Dr. Rosen recommends Gelmix for infants with reflux who are breastfed or receiving amino acid formulas. Cereal does not work for breastmilk or amino acid formulas.
- For infants, acid suppression, especially proton pump inhibitors, have not been shown to be effective but could contribute to a higher risk of allergies, infections and possibly bone complications.
- The podcast reviewed the rationale for a time-limited trial of hydrolysates for infants with reflux symptoms due to the overlap of symptoms between reflux and MSPI. However, if it is not effective in several weeks, then it should be stopped.
- Dr. Rosen does use “spit-up formulas” which can help reduce reflux symptoms and potentially help with swallow dysfunction. These are particularly well-suited for NG tubes as additional cereal in other formulas result in clogged NG tubes.
- Several new technologies have helped understand esophageal physiology much better including pH-impedance, high-resolution manometry and FLIP device. PH-impedance can help better categorize reflux symptoms into non-erosive reflux disease, reflux hypersensitivity, and functional heartburn; however, this test is used fairly infrequently at Dr. Rosen’s center as the test is burdensome.
- For older children/teenagers with functional heartburn symptoms, Dr. Rosen most frequent neuromodulator is gabapentin, which may alleviate coughing as well.
- Fundoplications have fallen out of favor and are undertaken much less frequently. The use of blenderized formulas or gastrojejunostomy tubes are often used to manage reflux symptoms in patients with neurologic impairment.
- Other treatments like prucalopride are emerging but quite limited in use in part due to lack of insurance coverage/cost.
- Red throat on ENT exam is not specific for reflux
- Aspiration, not reflux, is a common reason for infants who have coughing or BRUEs
- In infants, nonacid reflux is the main issue, not acid reflux
My take: If you like one of these podcasts, is it proper to say “I liked hearing your bowel sounds?”
If you want to listen to the episode click this link: https://www.buzzsprout.com/581062/10918260 or listen to it on apple podcast, Spotify, or where every you listen to podcasts.
Related article: S Yang et al. J Pediatr 2022; 245: 158-164. Pediatric Prescriptions of Proton Pump Inhibitors in France (2009-2019): A Time-Series Analysis of Trends and Practice Guidelines Impact Key findings:
- Between 2009 and 2019, the PPI prescription rate increased by 41% in the overall pediatric population (+110% in infants)
- There was a a mean PPI prescription rate of 52.5 per 1000 with the highest prescription rate in infants (131.5 per 1000 children)
- There was a seasonal pattern with prescriptions increased in the winter compared with the summer
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