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Vol. 90. Núm. 2.
Páginas 105-118 (Março - Abril 2014)
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Vol. 90. Núm. 2.
Páginas 105-118 (Março - Abril 2014)
ARTIGO DE REVISÃO
Open Access
Gastroesophageal reflux disease: exaggerations, evidence and clinical practice
Doença do refluxo gastroesofágico: exageros, evidências e a prática clínica
Visitas
12018
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
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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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Referências
[1]
Y. Vandenplas, C.D. Rudolph, C. Di Lorenzo, E. Hassall, G. Liptak, L. Mazur, et al.
Pediatric gastroesophageal reflux clinicalpractice guidelines: joint recommendations of the North Amer-ican Society for Pediatric Gastroenterology, Hepatology, andNutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN).
J Pediatr Gastroenterol Nutr., 49 (2009), pp. 498-547
[2]
S.R. Orenstein, F. Izadnia, S. Khan.
Gastroesophageal reflux disease in children.
Gastroenterol Clin North Am., 28 (1999), pp. 947-969
[3]
J.R. Lightdale, D.A. Gremse.
Section on Gastroenterology Hepatology, and Nutrition Gastroesophageal reflux: management guidance for the pediatrician.
Pediatrics., 131 (2013), pp. e1684-e1695
[4]
R. van der Pol, M. Smite, M.A. Benninga, M.P. van Wijk.
Non-pharmacological therapies for GERD in infants and children.
JPediatr Gastroenterol Nutr., 53 (2011), pp. S6-S8
[5]
T.G. Wenzl.
Role of diagnostic tests in GERD.
J Pediatr Gastroenterol Nutr., 53 (2011), pp. S4-S6
[6]
Ferreira CT, Carvalho E. Doenc¸a do refluxo gastroesofágico. Em: Carvalho E, Silva LR, Ferreira CT, editores. Gastroenterologia enutric¸ão em pediatria. Barueri, SP: Metha; 2012. p. 91-132.
[7]
H.S. Jang, J.S. Lee, G.Y. Lim, B.G. Choi, G.H. Choi, S.H. Park.
Correlation of color Doppler sonographic findings with pH measurements in gastroesophageal reflux in children.
J Clin Ultrasound., 29 (2001), pp. 212-217
[8]
A. Savino, C. Cecamore, M.F. Matronola, A. Verrotti, A. Mohn, F. Chiarelli, et al.
US in the diagnosis of gastroesophageal refluxin children.
Pediatr Radiol., 42 (2012), pp. 515-524
[9]
R.B. Colletti, D.L. Christie, S.R. Orenstein.
Statement of the North American Society for Pediatric Gastroenterology and Nutrition (NASPGN) Indications for pediatric esophageal pH monitoring.
J Pediatr Gastroenterol Nutr., 21 (1995), pp. 253-262
[10]
P.E. Putnam.
Obituary: the death of the pH probe.
J Pediatr., 157 (2010), pp. 878-880
[11]
E. Hassall.
Esophageal pH study: rumors of its death are greatly exaggerated.
J Pediatr., 159 (2011), pp. 519
[12]
T.G. Wenzl, C. Moroder, M. Trachterna, M. Thomson, J. Silny, G. Heimann, et al.
Esophageal pH monitoring and impedance measurement: a comparison of two diagnostic tests for gastroesophageal reflux.
J Pediatr Gastroenterol Nutr., 34 (2002), pp. 519-523
[13]
T.G. Wenzl, M.A. Benninga, C.M. Loots, S. Salvatore, Y. Vandenplas.
ESPGHAN EURO-PIG Work ing Group Indications, methodology, and interpretation of combined esophageal impedance-pH monitoring in children: ESPGHAN EURO-PIG standard protocol.
J Pediatr Gastroenterol Nutr., 55 (2012), pp. 230-234
[14]
Y. Vandenplas, G. Veereman-Wauters, E. De Greef, T. Devreker, B. Hauser, M. Benninga, et al.
Gastrointestinal manifestation of cow's milk protein allergy or intolerance and gastrointestinal motility.
J Pediatr Gastroenterol Nutr., 53 (2011), pp. S15-S17
[15]
O. Borrelli, V. Mancini, N. Thapar, V. Giorgio, M. Elawad, S. Hill, et al.
Cow's milk challenge increases weakly acidic reflux in childrenwith cow's milk allergy and gastroesophageal reflux disease.
J Pediatr., 161 (2012), pp. 476-481
[16]
G. Iacono, A. Carroccio, F. Cavataio, G. Montalto, KazmierskaI, D. Lorello, et al.
Gastroesophageal reflux and cow's milkallergy in infants: a prospective study.
J Allergy Clin Immunol., 97 (1996), pp. 822-827
[17]
R.G. Nielsen, C. Bindslev-Jensen, S. Kruse-Andersen, S. Husby.
Severe gastroesophageal reflux disease and cow milk hypersensitivity in infants and children: disease association and evaluation of a new challenge procedure.
J Pediatr Gastroenterol Nutr., 39 (2004), pp. 383-391
[18]
F. Cavataio, G. Iacono, G. Montalto, M. Soresi, M. Tumminello, A. Carroccio.
Clinical and pH-metric characteristics of gastrooesophageal reflux secondary to cows’ milk protein allergy.
Arch Dis Child., 75 (1996), pp. 51-56
[19]
F. Cavataio, G. Iacono, G. Montalto, M. Soresi, M. Tumminello, P. Campagna, et al.
Gastroesophageal reflux associated with cow'smilk allergy in infants: which diagnostic examinations are useful?.
Am J Gastroenterol., 91 (1996), pp. 1215-1220
[20]
S. Koletzko, B. Niggemann, A. Arato, J.A. Dias, R. Heuschkel, S. Husby, et al.
Diagnostic approach and management of cow's-milk protein allergy in infants and children: ESPGHAN GICommittee practical guidelines.
J Pediatr Gastroenterol Nutr., 55 (2012), pp. 221-229
[21]
A.G. Catto-Smith, D. Tan, D.G. Gall, R.B. Scott.
Rat gastric motorresponse to food protein-induced anaphylaxis.
Gastroenterology., 106 (1994), pp. 1505-1513
[22]
A.M. Ravelli, P. Tobanelli, S. Volpi, A.G. Ugazio.
Vomiting and gastricmotility in infants with cow's milk allergy.
J Pediatr Gastroenterol Nutr., 32 (2001), pp. 59-64
[23]
M.G. chäppi, O. Borrelli, D. Knafelz, S. Williams, V.V. Smith, MillaPJ, et al.
Mast cell-nerve interactions in children with functional dyspepsia.
J Pediatr Gastroenterol Nutr., 47 (2008), pp. 472-480
[24]
S. Emerenziani, D. Sifrim.
Gastroesophageal reflux and gastricemptying, revisited.
Curr Gastroenterol Rep., 7 (2005), pp. 190-195
[25]
C. Braegger, A. Chmielewska, T. Decsi, S. Kolacek, W. Mihatsch, L. Moreno, et al.
Supplementation of infant formula with probiotics and/or prebiotics: a systematic review and comment bythe ESPGHAN committee on nutrition.
J Pediatr Gastroenterol Nutr., 52 (2011), pp. 238-250
[26]
A. Garzi, M. Messina, F. Frati, L. Carfagna, L. Zagordo, M. Belcastro, et al.
An extensively hydrolysed cow's milk formula improves clinical symptoms of gastroesophageal reflux and reduces thegastric emptying time in infants.
Allergol Immunopathol (Madr)., 30 (2002), pp. 36-41
[27]
R.G. Nielsen, C. Fenger, C. Bindslev-Jensen, S. Husby.
Eosinophilia in the upper gastrointestinal tract is not a characteristic featurein cow's milk sensitive gastro-oesophageal reflux disease Measurement by two methodologies.
J Clin Pathol., 59 (2006), pp. 89-94
[28]
J. Semeniuk, M. Kaczmarski, M. U'scinowicz.
Manometric study of lower esophageal sphincter in children with primary acid gastroesophageal reflux and acid gastroesophageal reflux secondary to food allergy.
Adv Med Sci., 53 (2008), pp. 283-292
[29]
J. Semeniuk, M. Kaczmarski, M. U'scinowicz.
Endoscopic picture of esophagitis in children with primary and secondary acid gastroesophageal reflux.
Pol Merkur Lekarski., 24 (2008), pp. 212-218
[30]
J. Semeniuk, M. Kaczmarski, J. Wasilewska.
Serum gastrin concentrations in children with primary gastroesophageal reflux andgastroesophageal reflux secondary to cow's milk allergy.
Adv Med Sci., 56 (2011), pp. 186-192
[31]
F. Farahmand, M. Najafi, P. Ataee, V. Modarresi, T. Shahraki, N. Rezaei.
Cow's milk allergy among children with gastroesophageal reflux disease.
Gut Liver., 5 (2011), pp. 298-301
[32]
A. Horvath, P. Dziechciarz, H. Szajewska.
The effect of thickenedfeed interventions on gastroesophageal reflux in infants: systematic review and meta-analysis of randomized, controlled trials.
Pediatrics., 122 (2008), pp. e1268-e1277
[33]
W.R. Craig, A. Hanlon-Dearman, C. Sinclair, S. Taback, M. Moffatt.
Metoclopramide, thickened feedings, and positioning for gastro- oesophagealrefluxinchildrenundertwoyears.
CochraneDatabase Syst Rev., (2004), pp. CD003502
[34]
Dunne CE, Bushee JL, Argikar UA. Metabolism of bromopride inmouse, rat, rabbit, dog, monkey, and human hepatocytes. Drug Metab Pharmacokinet. 2013 Apr 23.[Epub ahead of print].
[35]
D.S. Pritchard, N. Baber, T. Stephenson.
Should domperidone beused for the treatment of gastro-oesophageal reflux in children? Systematic review of randomized controlled trials in children aged 1 month to 11 years old.
Br J Clin Pharmacol., 59 (2005), pp. 725-729
[36]
M.C. Vieira, N.I. Miyague, K. Van Steen, S. Salvatore, Y. Vandenplas.
Effects of domperidone on QTc interval in infants.
Acta Paediatr., 101 (2012), pp. 494-496
[37]
D. Djeddi, G. Kongolo, C. Lefaix, J. Mounard, A. Léké.
Effect of domperidone on QT interval in neonates.
J Pediatr., 153 (2008), pp. 663-666
[38]
E. Hassall.
Over-prescription of acid-suppressing medications ininfants: how it came about, why it's wrong, and what to doabout it.
J Pediatr., 160 (2012), pp. 193-198
[39]
R.B. Canani, P. Cirillo, P. Roggero, C. Romano, B. Malamisura, G. Terrin, et al.
Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia inchildren.
Pediatrics., 117 (2006), pp. e817-e820
[40]
E. Hassall.
Uses and abuses of acid-suppression therapy in children.
J Pediatr Gastroenterol Nutr., 53 (2011), pp. S8-S9
[41]
E. Untersmayr, E. Jensen-Jarolim.
The role of protein digestibility and antacids on food allergy outcomes.
J Allergy Clin Immunol., 121 (2008), pp. 1301-1308
[42]
T. Andersson, E. Hassall, P. Lundborg, R. Shepherd, M. Radke, M. Marcon, et al.
Pharmacokinetics of orally administered omeprazolein children International Pediatric Omeprazole Pharmacokinetic Group.
Am J Gastroenterol., 95 (2000), pp. 3101-3106
[43]
E. Hassall, D. Israel, R. Shepherd, M. Radke, A. Dalväg, SköldB, et al.
International Pediatric Omeprazole Study Group Omeprazole for treatment of chronic erosive esophagitis in children: a multicenter study of efficacy, safety, tolerability anddose requirements.
J Pediatr., 137 (2000), pp. 800-807
[44]
G. Tafuri, F. Trotta, H.G. Leufkens, N. Martini, L. Sagliocca, G. Traversa.
Off-label use of medicines in children: can available evi-dence avoid useless paediatric trials? The case of proton pumpinhibitors for the treatment of gastroesophageal reflux disease.
Eur J Clin Pharmacol., 65 (2009), pp. 209-216
[45]
R.J. van der Pol, M.J. Smits, M.P. van Wijk, T.I. Omari, M.M. Tabbers, M.A. Benninga.
Efficacy of protonpump inhibitors in children with gastroesophageal reflux disease: a systematic review.
Pediatrics., 127 (2011), pp. 925-935
[46]
E. Hassall, R. Shepherd, S. Koletzko, M. Radke, C. Henderson, P. Lundborg.
Long-term maintenance treatment with omeprazole inchildren with healed erosive oesophagitis: a prospective study.
Aliment Pharmacol Ther., 35 (2012), pp. 368-379
[47]
R. Fossmark, G. Johnsen, E. Johanessen, H.L. Waldum.
Rebound acid hypersecretion after long-term inhibition of gastric acid secretion.
Aliment Pharmacol Ther., 21 (2005), pp. 149-154
[48]
C. Reimer, B. Søndergaard, L. Hilsted, P. Bytzer.
Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after with drawal of therapy.
Gastroenterology., 137 (2009), pp. 80-87
[49]
Y. Vandenplas, H. Goyvaerts, R. Helven, L. Sacre.
Gastroesophageal reflux, as measured by 24-hour pH monitoring, in 509 healthy infants screened for risk of sudden infant death syndrome.
Pediatrics., 88 (1991), pp. 834-840
[50]
S.P. Nelson, E.H. Chen, G.M. Syniar, K.K. Christoffel.
Prevalence ofsymptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey Pediatric Practice Research Group.
Arch Pediatr Adolesc Med., 151 (1997), pp. 569-572
[51]
H. Winter, P. Kum-Nji, S.H. Mahomedy, J. Kierkus, M. Hinz, H. Li, et al.
Efficacy and safety of pantoprazole delayed-release granules for oral suspension in a placebo-controlled treatment- withdrawalstudy in infants 1-11 months old with symptomatic GERD.
J Pediatr Gastroenterol Nutr., 50 (2010), pp. 609-618
[52]
S.R. Orenstein, T.M. Shalaby, S.F. Kelsey, E. Frankel.
Natural his-tory of infant reflux esophagitis: symptoms and morphometric histology during one year without pharmacotherapy.
Am J Gastroenterol., 101 (2006), pp. 628-640
[53]
S.R. Orenstein, E. Hassall, W. Furmaga-Jablonska, S. Atkinson, M. Raanan.
Multicenter, double-blind, randomized, placebo- controlled trial assessing the efficacy and safety of proton pumpinhibitor lansoprazole in infants with symptoms of gastroe-sophageal reflux disease.
J Pediatr., 154 (2009), pp. 514-520
[54]
D.J. Moore, B.S. Tao, D.R. Lines, C. Hirte, M.L. Heddle, G.P. Davidson.
Double-blind placebo-controlled trial of omeprazole in irritable infants with gastroesophageal reflux.
J Pediatr., (2003), pp. 143-219
[55]
C. Lifschitz.
Thinking outside the box when dealing with patients with GERD and feeding problems.
J Pediatr Gastroenterol Nutr., 53 (2011), pp. 358
[56]
G. Karacetin, T. Demir, T. Erkan, F.C. Cokugras, B.A. Sonmez.
Maternal psychopathology and psychomotor development of children with GERD.
J Pediatr Gastroenterol Nutr., 53 (2011), pp. 380-385
[57]
S.R. Orenstein, E. Hassall.
Pantoprazole for symptoms of infant GERD: the emperor has no clothes!.
J Pediatr Gastroenterol Nutr., 51 (2010), pp. 537
[58]
S.R. Orenstein, E. Hassall.
Infants and proton pump inhibitors: tribulations, no trials.
J Pediatr Gastroenterol Nutr., 45 (2007), pp. 395-398
[59]
E. Hassall, D. Owen.
Long-term use of PPIs in children: we have questions.
Dig Dis Sci., 53 (2008), pp. 1158-1160
[60]
W.F. Balistreri.
The reflex to treat reflux - let's be conservative regarding gastroesophageal reflux (GER)!.
[61]
I.L. Chen, W.Y. Gao, A.P. Johnson, A. Niak, J. Troiani, J. Korvick, et al.
Proton pump inhibitor use in infants: FDA reviewer experience.
J Pediatr Gastroenterol Nutr., 54 (2012), pp. 8-14
[62]
J.J. Barron, H. Tan, J. Spalding, A.W. Bakst, J. Singer.
Proton pump inhibitor utilization patterns in infants.
J Pediatr Gastroenterol Nutr., 45 (2007), pp. 421-427
[63]
D.M. Diaz, H.S. Winter, R.B. Colletti, G.D. Ferry, C.D. Rudolph, S.J. Czinn, et al.
Knowledge, attitudes and practice styles of North American pediatricians regarding gastroesophageal reflux disease.
J Pediatr Gastroenterol Nutr., 45 (2007), pp. 56-64
[64]
S.R. Orenstein, J.D. McGowan.
Efficacy of conservative therapyas taught in the primary care setting for symptoms suggestinginfant gastroesophageal reflux.
J Pediatr., 152 (2008), pp. 310-314
[65]
T.M. Shalaby, S.R. Orenstein.
Efficacy of telephone teaching of conservative therapy for infants with symptomatic gastroesophageal reflux referred by pediatricians to pediatric gastroenterologists.
J Pediatr., 142 (2003), pp. 57-61
[66]
E. Hassall.
Talk is cheap. often effective: symptoms in infants often respond to non-pharmacologic measures.
J Pediatr., 152 (2008), pp. 301-303
[67]
S.J. Czinn, S. Blanchard.
Gastroesophageal reflux disease inneonates and infants: when and how to treat.
Paediatr Drugs., 15 (2013), pp. 19-27
[68]
D. Forbes.
Mewling and puking: infantile gastroesophageal refluxin the 21st century.
J Paediatr Child Health., 49 (2013), pp. 259-263
[69]
V. Tolia, G. Ferry, T. Gunasekaran, B. Huang, R. Keith, L. Book.
Efficacy of lansoprazole in the treatment of gastroesophageal reflux disease in children.
J Pediatr Gastroenterol Nutr., 35 (2002), pp. S308-S318
[70]
D. Gremse, H. Winter, V. Tolia, T. Gunasekaran, W.J. Pan, KarolM, et al.
Pharmacokinetics and pharmacodynamics of lansopra-zole in children with gastroesophageal reflux disease.
J Pediatr Gastroenterol Nutr., 35 (2002), pp. S319-S326
[71]
T. Gunasekaran, S. Gupta, D. Gremse, M. Karol, W.J. Pan, Y.L. Chiu, et al.
Lansoprazole in adolescents with gastroesophageal reflux disease: pharmacokinetics, pharmacodynamics, symptomrelief efficacy, and tolerability.
J Pediatr Gastroenterol Nutr., 35 (2002), pp. S327-S335
[72]
S. Fiedorek, V. Tolia, B.D. Gold, B. Huang, J. Stolle, C. Lee, et al.
Efficacy and safety of lansoprazole in adolescents with symptomatic erosive and non-erosive gastroesophageal refluxdisease.
J Pediatr Gastroenterol Nutr., 40 (2005), pp. 319-327
[73]
B.D. Gold, T. Gunasekaran, V. Tolia, G. Wetzler, H. Conter, B. Traxler, et al.
Safety and symptom improvement with esomeprazole in adolescents with gastroesophageal reflux disease.
J Pediatr Gastroenterol Nutr., 45 (2007), pp. 520-529
[74]
V. Tolia, N.N. Youssef, M.A. Gilger, B. Traxler, M. Illueca.
Esomeprazole for the treatment of erosive esophagitis in children: aninternational, multicenter, randomized, parallel-group, double-blind (for dose) study.
BMC Pediatr., 10 (2010), pp. 41
[75]
R. Baker, V.M. Tsou, J. Tung, S.S. Baker, H. Li, W. Wang, et al.
Clinical results from a randomized, double-blind, dose-ranging studyof pantoprazole in children aged 1 through 5 years with symptomatic histologic or erosive esophagitis.
Clin Pediatr (Phila)., 49 (2010), pp. 852-865
[76]
B.K. Tammara, J.E. Sullivan, K.G. Adcock, J. Kierkus, J. Giblin, N. Rath, et al.
Randomized, open-label, multicentre pharma-cokinetic studies of two dose levels of pantoprazole granules in infants and children aged 1 month through < 6 yearswith gastro-oesophageal reflux disease.
Clin Pharmacokinet., 50 (2011), pp. 541-550
[77]
R.M. Ward, G.L. Kearns, B. Tammara, P. Bishop, M.A. O’Gorman, L.P. James, et al.
A multicenter, randomized, open-label, pharmacokinetics and safety study of pantoprazole tablets in children andadolescents aged 6 through 16 years with gastroesophagealreflux disease.
J Clin Pharmacol., 51 (2011), pp. 876-887
[78]
M. Sandström, G. Davidson, V. Tolia, J.E. Sullivan, G. Långström, P. Lundborg, I. Phase, et al.
multicenter, randomized, open- labelstudy evaluating the pharmacokinetics and safety profile ofrepeated once-daily doses of intravenous esomeprazole in children 0 to 17 years of age.
Clin Ther., 34 (2012), pp. 1828-1838
[79]
M. Kukulka, J. Wu, M.C. Perez.
Pharmacokinetics and safety of dexlansoprazole MR in adolescents with symptomatic GERD.
J Pediatr Gastroenterol Nutr., 54 (2012), pp. 41-47
[80]
H. Winter, T. Gunasekaran, V. Tolia, F. Gottrand, P.N. Barker, M. Illueca.
Esomeprazole for the treatment of GERD in infants ages 1-11 months.
J Pediatr Gastroenterol Nutr., 55 (2012), pp. 14-20

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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Os artigos submetidos a partir de 1º de setembro de 2018, que forem aceitos para publicação no Jornal de Pediatria, estarão sujeitos a uma taxa para que tenham sua publicação garantida. O artigo aceito somente será publicado após a comprovação do pagamento da taxa de publicação. Ao submeterem o manuscrito a este jornal, os autores concordam com esses termos. A submissão dos manuscritos continua gratuita. Para mais informações, contate assessoria@jped.com.br. Articles submitted as of September 1, 2018, which are accepted for publication in the Jornal de Pediatria, will be subject to a fee to have their publication guaranteed. The accepted article will only be published after proof of the publication fee payment. By submitting the manuscript to this journal, the authors agree to these terms. Manuscript submission remains free of charge. For more information, contact assessoria@jped.com.br.
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