Pediatrics. 2013 May;131(5):e1684-95. doi: 10.1542/peds.2013-0421. Epub 2013 Apr 29.
Recent comprehensive guidelines developed by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition define the common entities of gastroesophageal reflux (GER) as the physiologic passage of gastric contents into the esophagus and gastroesophageal reflux disease (GERD) as reflux associated with troublesome symptoms or complications. The ability to distinguish between GER and GERD is increasingly important to implement best practices in the management of acid reflux in patients across all pediatric age groups, as children with GERD may benefit from further evaluation and treatment, whereas conservative recommendations are the only indicated therapy in those with uncomplicated physiologic reflux. This clinical report endorses the rigorously developed, well-referenced North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines and likewise emphasizes important concepts for the general pediatrician. A key issue is distinguishing between clinical manifestations of GER and GERD in term infants, children, and adolescents to identify patients who can be managed with conservative treatment by the pediatrician and to refer patients who require consultation with the gastroenterologist. Accordingly, the evidence basis presented by the guidelines for diagnostic approaches as well as treatments is discussed. Lifestyle changes are emphasized as first-line therapy in both GER and GERD, whereas medications are explicitly indicated only for patients with GERD. Surgical therapies are reserved for children with intractable symptoms or who are at risk for life-threatening complications of GERD. Recent black box warnings from the US Food and Drug Administration are discussed, and caution is underlined when using promoters of gastric emptying and motility. Finally, attention is paid to increasing evidence of inappropriate prescriptions for proton pump inhibitors in the pediatric population.
最近，北美儿科学会胃肠病学、肝脏病学和营养学制定了综合指南，将胃食管反流（GER）的常见病症定义为胃内容物生理性地进入食管，以及胃食管反流病（GERD）为反流相关的麻烦症状或并发症。区分 GER 和 GERD 的能力对于在所有儿科年龄组的酸反流管理中实施最佳实践变得越来越重要，因为 GERD 患儿可能受益于进一步评估和治疗，而对于没有复杂生理性反流的患儿，保守建议是唯一的治疗方法。本临床报告认可经过严格制定、有充分参考依据的北美儿科学会胃肠病学、肝脏病学和营养学指南，并同样强调了普通儿科医生的重要概念。一个关键问题是区分足月婴儿、儿童和青少年 GER 和 GERD 的临床表现，以确定可以由儿科医生通过保守治疗管理的患者，并将需要咨询胃肠病学家的患者转介出去。因此，讨论了指南中针对诊断方法和治疗方法的证据基础。生活方式改变被强调为 GER 和 GERD 的一线治疗方法，而药物仅明确用于 GERD 患者。手术治疗保留给有难治性症状或有 GERD 危及生命并发症风险的儿童。讨论了美国食品和药物管理局最近的黑框警告，并强调了在使用促进胃排空和动力的药物时要谨慎。最后，关注在儿科人群中质子泵抑制剂的不适当处方的增加证据。
