Cochrane for Clinicians

Putting Evidence into Practice

Pharmacologic Therapy for Gastroesophageal Reflux Disease in Children


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Am Fam Physician. 2015 Sep 1;92(5):351-352.

Author disclosure: No relevant financial affiliations.

Clinical Question

Are medications for gastroesophageal reflux disease (GERD) safe and effective in children?

Evidence-Based Answer

Among infants younger than 12 months diagnosed with GERD, weak evidence supports the use of proton pump inhibitors (PPIs) and histamine H2 antagonists. Among children 12 months and older, studies have shown moderate benefit from PPIs and weak benefit from H2 antagonists for providing symptomatic relief and/or improving histologic or pH indices of disease. No serious adverse effects were noted in the studies reviewed for any of the treatments. (Strength of Recommendation: B, based on inconsistent randomized controlled trials [RCTs].)

Practice Pointers

Gastroesophageal reflux is a benign, self-limited process caused by transient, intermittent relaxations of the lower esophageal sphincter. Gastroesophageal reflux often occurs postprandially and lasts less than three minutes with minimal symptoms. Most children with gastroesophageal reflux have normal weight gain, minimal irritability, and no respiratory symptoms.1 GERD occurs when reflux symptoms are more severe or when complications arise.2 The classic picture of infantile GERD is an irritable baby with poor weight gain and arching of the back during feeding, but symptoms may also include wheezing or coughing.1,2

The authors of this Cochrane review evaluated 24 RCTs examining pharmacologic management of GERD in children younger than 16 years. A subgroup analysis focused on infants younger

Author disclosure: No relevant financial affiliations.

The practice recommendations in this activity are available at


Tighe M, Afzal NA, Bevan A, Hayen A, Munro A, Beattie RM. Pharmacological treatment of children with gastro-oesophageal reflux. Cochrane Database Syst Rev. 2014;(11):CD008550.


show all references

1. Lightdale JR, Gremse DA; Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013;131(5):e1684–e1695....

2. Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49(4):498–547.

3. Centers for Medicare and Medicaid Services. Proton pump inhibitors: use in pediatric patients. August 2013. Accessed August 5, 2015.

4. Davies I, Burman-Roy S, Murphy MS; Guideline Development Group. Gastro-oesophageal reflux disease in children: NICE guidance. BMJ. 2015;350:g7703.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at


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