Drug management of Infants Gastro-Oesophageal Reflux Disease (GORD) A systematic review

Abstract

ABSTRACT: Introduction: Gastro-oesophageal reflux (GOR) is a normal physiological event involving the passage of gastric contents into the oesophagus (1). Gastro-oesophageal reflux disease (GORD) can cause many problematic symptoms, such as heartburn, regurgitation and sleep disturbance (1). In addition, it can have more serious complications due to the acidity of the gastric contents. Anaemia can occur in infants due to frequent vomiting that may be a result of GORD. Furthermore, sudden infant death syndrome is associated with GORD (3). Prevalence of GORD in infants is approximately 20-40%, with 67% of infants experiencing GOR in their fourth month (8). This systematic review focuses on the pharmacological therapy used to manage GORD in infants, such as proton-pump inhibitors (PPIs), H2receptor antagonists (H2RAs), thickened formula and alginate therapy. It seeks to identify which group has a higher efficacy in terms of treating GORD in infants. Objectives: This systematic review aims to determine which drugs from the currently available pharmacological interventions have the highest efficacy when treating GORD and minimize symptoms in three groups of infants: preterm, neonate and infant. In addition, it asks whether there are any differences between them in terms of response. Methods: We searched electronic databases such as PubMed/Medline, Embase and Cochrane Database of Systematic Reviews to find eligible studies by using specific keywords and their corresponding MeSH terms, such as GORD, between 2014 and August 2020. In addition, we searched in the references to determine if there were any relevant infant studies on medical treatment for gastro oesophageal reflux disease. Results: A total of 7 studies (717 participants) contributed data to the review. It was not possible to conduct meta-analysis whether between agents in the same class or between different classes, due to heterogeneity of outcome and study designs. Some evidence proved that GORD symptoms have shown clinical improvement with proton pump inhibitors (PPIs), but it was not possible to determine a statistical supremacy of one PPI medication over another. The H2 antagonist group showed the same result. 3 Moderate-quality evidence indicates that alginate therapy (Gaviscon Infant®) and thickened formula have statically improved symptoms in infants with GORD. No RCTs on prokinetics were eligible to be assessed in this review. Conclusion: infants’ GORD symptoms have clinically improved with available pharmacological therapy included in this review. Results showed a statistically significant difference in symptoms before and after treatment. This was established in short-term studies particularly with alginate therapy (Gaviscon Infant®) and thickened formula (NAN, A, R). Due to insufficient studies with head-to-head or independent placebo-controlled comparison within the available pharmacological therapies, the efficacy determination and recommendation stands difficult to conduct. More RCTs with longer follow-up times are recommended.