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Type: Journal article
Title: Acid suppressants for managing gastro-oesophageal reflux and gastro-oesophageal reflux disease in infants: a national survey
Author: Bell, J.C.
Schneuer, F.J.
Harrison, C.
Trevena, L.
Hiscock, H.
Elshaug, A.G.
Nassar, N.
Citation: Archives of Disease in Childhood, 2018; 103(7):660-664
Publisher: BMJ Publishing Group
Issue Date: 2018
ISSN: 0003-9888
Statement of
Jane C Bell, Francisco J Schneuer, Christopher Harrison, Lyndal Trevena, Harriet Hiscock, Adam G Elshaug, Natasha Nassar
Abstract: Objectives: To evaluate the diagnosis and management of reflux and gastro-oesophageal reflux disease (GORD) in infants aged <1 year presenting to general practitioners (GPs). Design, setting and participants: A nationally representative, prospective, cross-sectional survey of GP activity in Australia, 2006–2016 (Bettering the Evaluation And Care of Health Study). Annually, a random sample of around 1000 GPs recorded details for 100 consecutive visits with consenting, unidentified patients. Outcome measures: Diagnoses of reflux and GORD and their management including prescribing of acid-suppressant medicines (proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs)) and counselling, advice or education. Results: Of all infants’ visits, 512 (2.7%) included a diagnosis of reflux (n=413, 2.2%) or GORD (n=99, 0.5%). From 2006 to 2016, diagnostic rates decreased for reflux and increased for GORD. Prescribing of acid suppressants occurred in 43.6% visits for reflux and 48.5% visits for GORD, similar to rates of counselling, advice or education (reflux: 38.5%, GORD: 43.4% of visits). Prescribing of PPIs increased (statistically significant only for visits for reflux), while prescribing of H2RAs decreased. Conclusions: Overprescribing of acid suppressants to infants may be occurring. In infants, acid-suppressant medicines are no better than placebo and may have significant negative side effects; however, guidelines are inconsistent. Clear, concise and consistent guidance is needed. GPs and parents need to understand what is normal and limitations of medical therapy. We need a greater understanding of the influences on GP prescribing practices, of parents’ knowledge and attitudes and of the pressures on parents of infants with these conditions.
Keywords: gastroenterology
general paediatrics
general practice
health services research
Rights: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
DOI: 10.1136/archdischild-2017-314161
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