Are Doctors Over-Prescribing Anti-Reflux Medications for Infants with Regurgitation?

Tracy Davenport, Ph.D. Health Guide
  • This is a hard question to answer based only on a recent study being reported in most of the popular press sites.

     

    Dr. Vikram Khoshoo and his colleagues recently published an article in Pediatrics concluding that the majority of infants who are prescribed anti-reflux drugs do not meet diagnostic criteria for gastroesophageal reflux disease. For the benefit of both healthcare providers and families, I am providing you with some very important information to consider regarding this study.

     

    Sample Size

    Dr. Khoshoo based his findings on 44 infants. For those of you familiar with research methods, you know this number is too small for most acceptable statistical methods. (Dr. Khoshoo most likely understood this fact as well, and therefore just reports his findings as percentages, instead of significant findings). This is an important fact to keep in mind, when some in the popular press are implying that his findings were significant.

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    Select Population

    Dr. Khoshoo excluded from his study any infant who was born preterm, had any underlying illness, had a lower respiratory tract illness, or was exposed directly or indirectly to cigarette smoke. As many of you know, each of these conditions is highly correlated with acid reflux. One has to wonder what the percentages would have looked like if he would have included these infants in his study.

     

    PH Cutoff

    In his study, Dr. Khoshoo only considered a pH below 4 as a marker of GERD. This is an acidic level that most in the field agree can cause discomfort to a patient in the lower esophagus. However, studies abound that demonstrate pH numbers greater than 4 can cause extreme discomfort and damage to the upper portion of the esophagus, lungs, and upper airway, if extraesophageal reflux is present.

     

    Non-Acidic Reflux

    PH testing only detects acidic stomach contents. As was reported in my previous blog, non-acidic reflux can also cause GERD symptoms in patients.

     

    Astute clinicians know that GERD can be extremely difficult to diagnose. Like any study, Dr. Khoshoo's research can certainly be added to our pool of knowledge. I only caution doctors and parents alike not to jump to any conclusions based on his article's title.

     

    More information on GERD diagnosis

    Infant GERD: The ultimate parent's guide

     

Published On: November 07, 2007