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Vol. 90. Núm. 2.Março - Abril 2014
Páginas 99-214
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Vol. 90. Núm. 2.Março - Abril 2014
Páginas 99-214
ARTIGO DE REVISÃO
DOI: 10.1016/j.jpedp.2013.05.010
Open Access
Gastroesophageal reflux disease: exaggerations, evidence and clinical practice
Doença do refluxo gastroesofágico: exageros, evidências e a prática clínica
Visitas
7512
Cristina Targa Ferreiraa,b,c,
Autor para correspondência
cristinatarga@terra.com.br

Corresponding author.
, Elisa de Carvalhod,e,f,g, Vera Lucia Sdepanianc,h, Mauro Batista de Moraisc,h,i, Mário César Vieirac,j,k, Luciana Rodrigues Silvac,l,m
a Serviço de Gastroenterologia Pediátrica, Hospital da Criança Santo Antônio, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brasil
b Departamento de Pediatria, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil
c Departamento de Gastroenterologia, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brasil
d Unidade de Pediatria do Hospital de Base do Distrito Federal, DF, Brasil
e Hospital da Criança de Brasília, DF, Brasil
f Centro Universitário de Brasília, DF, Brasil
g Departamento de Pediatria e Gastroenterologia, Sociedade Brasileira de Pediatria, Brasília, DF, Brasil
h Departamento de Pediatria, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil
i Clínica de Especialidades Pediátricas, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
j Departamento de Pediatria, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
k Serviço de Gastroenterologia Pediátrica, Hospital Pequeno Príncipe, Curitiba, PR, Brasil
l Serviço de Gastroenterologia Pediátrica e Hepatologia, Universidade Federal da Bahia, Salvador, BA, Brasil
m Academia Brasileira de Pediatria, Rio de Janeiro, RJ, Brasil
Este item recebeu
7512
Visitas

Under a Creative Commons license
Informação do artigo
Abstract
Objective

there are many questions and little evidence regarding the diagnosis and treatment of gastroesophageal reflux disease (GERD) in children. The association between GERD and cow's milk protein allergy (CMPA), overuse of abdominal ultrasonography for the diagnosis of GERD, and excessive pharmacological treatment, especially proton-pump inhibitors (PPIs) are some aspects that need clarification. This review aimed to establish the current scientific evidence for the diagnosis and treatment of GERD in children.

Data source

a search was conducted in the MEDLINE, PubMed, LILACS, SciELO, and Cochrane Library electronic databases, using the following keywords gastroesophageal reflux; gastroesophageal reflux disease; proton-pump inhibitors; and prokinetics; in different age groups of the pediatric age range; up to May of 2013.

Data synthesis

abdominal ultrasonography should not be recommended to investigate gastroesophageal reflux (GER). Simultaneous treatment of GERD and CMPA often results in unnecessary use of medication or elimination diet. There is insufficient evidence for the prescription of prokinetics to all patients with GER/GERD. There is little evidence to support acid suppression in the first year of life, to treat nonspecific symptoms suggestive of GERD. Conservative treatment has many benefits and with low cost and no side-effects.

Conclusions

there have been few randomized controlled trials that assessed the management of GERD in children and no examination can be considered the gold standard for GERD diagnosis. For these reasons, there are exaggerations in the diagnosis and treatment of this disease, which need to be corrected.

Keywords:
Gastroesophageal reflux disease
Gastroesophageal reflux
Proton pump inhibitors
Proton pump inhibitors/therapeutic use
Infant
Child
Resumo
Objetivo

há muitas dúvidas e poucas evidências para o diagnóstico e tratamento da doença do refluxo gastroesofágico (DRGE) na criança. A relação entre a DRGE e a alergia às proteínas do leite de vaca (APLV), o uso exagerado da ultrassonografia abdominal para diagnóstico da DRGE e o excesso de medicamentos, especialmente dos inibidores de bomba de prótons (IBP), são alguns aspectos que necessitam esclarecimentos. Esta revisão tem como objetivo estabelecer as evidências científicas atuais para o diagnóstico e tratamento da DRGE em pediatria.

Fontes dos dados

foram pesquisadas nas bases de dados eletrônicos do Medline, Pubmed, Lilacs, Cochrane Library e Scielo, nas diferentes faixas etárias da pediatria, até maio de 2013, as seguintes palavras-chave: refluxo gastroesofágico, doença do refluxo gastroesofágico, inibidores da bomba de prótons e procinéticos.

Síntese dos dados

a ultrassonografia de abdome não deve ser recomendada para pesquisa de refluxo gastroesofágico (RGE). O tratamento simultâneo da DRGE e da APLV induz, muitas vezes, ao uso desnecessário de medicação ou dieta de exclusão. Não existem evidências suficientes para prescrição de procinéticos em todos os portadores de RGE/DRGE. Poucas evidências fornecem suporte para a supressão ácida, no primeiro ano de vida, para tratamento de sintomas inespecíficos, sugestivos de DRGE. O tratamento conservador traz muitos benefícios e poucos gastos, sem efeitos colaterais.

Conclusões

existem poucos estudos controlados e randomizados que avaliam a DRGE na criança e nenhum exame pode considerado padrão-ouro para o seu diagnóstico. Por esses motivos, ocorrem exageros no diagnóstico e no tratamento dessa doença, e que necessitam ser corrigidos.

Palavras-chave:
Doença do refluxo gastroesofágico
Refluxo gastroesofágico
Inibidores de bomba de prótons
Inibidores da bombade prótons/uso terapêutico
Lactente
Criança
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Como citar este artigo: Ferreira CT, Carvalho E, Sdepanian VL, Morais MB, Vieira MC, Silva LR. Gastroesophageal reflux disease: exaggerations, evidence and clinical practice. J Pediatr (Rio J). 2014;90:105-18.

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