What is known about acid blockers and motility agents:

Proton pump inhibitors (PPI):

• Change acidic GER to non-acidic GER, without proven benefit on symptoms like discomfort, crying duration or feeding refusal.
• Are associated with a significant increase in severe
• Have an impact on the gut microbiome

Motility agents:

• Lack evidence supporting a benefit on symptoms of GER in
• Have side effects on the heart and nervous
•  Non-pharmacological measures may be used to reduce physiological regurgitation if perceived as a problem.

How to talk with patients and parents about acid blockers and motility agents/GER:

•  Reflux is not a common cause of unexplained crying, irritability or distressed behavior in otherwise healthy infants. We will look for causes we can treat to help your child.
•  When we can exclude other causes, the best course of action is to undergo a trial with a formula tailored to be the most easily tolerated by the infant’s digestive tract.
•  Suppressing the natural acidity of the stomach is suppressing a natural defense mechanism of the body and is not free of harm.

This EAP recommendation is in accordance with the Choosing Wisely recommendations of:

• Switzerland: www.paediatrieschweiz.ch/choosingwisely
• Canada: https://choosingwiselycanada.org/recommendation/paediatrics/.
• Norway: https://www.legeforeningen.no/kloke-valg/til-helsepersonell/legeforeningens-anbefalinger/norsk-barnelegeforening/allergitesting/
• Australia: https://www.choosingwisely.org.au/recommendations/racp4.
• American Family Physicians Choosing Wisely: https://www.aafp.org/pubs/afp/collections/choosing-wisely/19.html
• Italy: https://choosingwiselyitaly.org/raccomandazione-prof/non-prescrivere-farmaci-anti-h2-inibitori-di-pompa-protonica-e-procinetici-nel- reflusso-gastroesofageo-rge-fisiologico-che-non-compromette-la-crescita-e-non-si-associa-a-segni-o-sintomi-sospetti/

References:

• Gieruszczak-Białek D, Konarska Z, Skórka A, Vandenplas Y, Szajewska H. No effect of proton pump inhibitors on crying and irritability in infants: systematic review of randomized controlled trials. J Pediatr. 2015 Mar;166(3):767-770.e3. PMID: 25556017

• Lassalle M, Zureik M, Dray-Spira R. Proton Pump Inhibitor Use and Risk of Serious Infections in Young Children. JAMA Pediatr. 2023 Oct 1;177(10):1028. PMID: 37578761
• Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J pediatr gastroenterol nutr. 2018 Mar;66(3):516–54. PMID: 29470322
• NICE guidelines. Gastro-oesophageal reflux disease in children and young people: diagnosis and management [Internet]. London: National Institute for Health and Care Excellence (NICE); 2019 [cited 2024 Mar 11]. PMID: 31944641

• Turk H, Hauser B, Brecelj J, Vandenplas Y, Orel R. Effect of proton pump inhibition on acid, weakly acid and weakly alkaline gastro-esophageal reflux in children. World J Pediatr. 2013 Feb;9(1):36–41. PMID: 23389331