Gastroesophageal reflux disease: could intervention in childhood reduce the risk of later complications?

Gastroesophageal reflux (GER) is a ubiquitous disorder in infants. Whereas infants typically outgrow regurgitation by 1 year of age, the prevalence of gastroesophageal reflux disease (GERD) symptoms in those aged 3 to >18 years ranges from 1.8% to 22%. The pathophysiology of GERD in children is similar to that in adults. However, children may present with gastroesophageal and extraesophageal symptoms distinct from classic heartburn. In addition to a growing awareness of the high prevalence of the disorder, increasing evidence supports GERD being a lifelong condition in some individuals that begins in childhood. Although the diagnostic workup in children compared with adults may differ, studies suggest that the early detection and treatment of GERD in childhood may result in better adult disease outcomes, improved quality of life, and decreased overall healthcare burden. Studies of proton pump inhibitor therapy in children confirm high rates of mucosal healing and GER symptom resolution, even in children whose symptoms did not respond to H2-receptor therapy or fundoplication procedures. Omeprazole, lansoprazole, and esomeprazole are formulated as capsules containing enteric-coated granules that can be sprinkled onto applesauce or other soft foods. Lansoprazole is also formulated as strawberry-flavored granules for suspension. These as well as other alternative dosing formulations expand the ability to administer these agents to children. Moreover, long-term studies in adults and in children demonstrate that these agents are safe and well tolerated, even at the higher milligram per kilogram doses that are often required in pediatric patients because of their greater hepatic metabolic capacity.