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Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0000000000000408
Original Article: Gastroenterology: PDF Only

Do Pediatricians Apply the 2009 NASPGHAN-ESPGHAN Guidelines for the Diagnosis and Management of Gastroesophageal Reflux After Being Trained?.

Quitadamo, Paolo; Urbonas, Vaidotas; Papadopoulou, Alexandra; Roman, Enriqueta; Pavkov, Danijela Jojkic; Orel, Rok; Dias, Jorge Amil; Kostovski, Aco; Miele, Erasmo; Villani, Alberto; Staiano, Annamaria

Published Ahead-of-Print
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Abstract

Aim: According to a recent survey, the 2009 NASPGHAN-ESPGHAN GER guidelines are poorly adhered to by European primary care pediatricians. The main issue raised from the survey was the prescription of unnecessary acid suppressive medications, especially in infants. No inquiry into the reasons was made. The primary objective of the present study was to assess the applicability of the guidelines in European primary care pediatricians undergoing specific trainings.

Methods: One hundred pediatricians involved in the previous survey agreed to participate and were randomly divided into 2 groups: one group was trained in the guidelines through an online podcast and the other group through a synopsis. During the following 3 months, each involved pediatrician was asked to enroll every consecutive infant, child or adolescent with suggestive reflux symptoms. For every enrolled patient pediatricians filled-in a report concerning their diagnostic and therapeutic choices.

Results: A total of 382 patients (M/F: 186/196, infants/children/adolescents: 194/123/65) were enrolled by pediatricians. Infants with unexplained crying and/or distressed behavior who were prescribed PPIs were 3.7% compared to 45.2% of the survey data obtained before the training (p < 0.05). Infants with uncomplicated recurrent regurgitation and vomiting who were prescribed PPIs were 4.5% against 37.1% of the baseline survey data (p < 0.05). The overall rate of children managed in full compliance with the guidelines was 46.1% after the training compared to 1.8% before the training (p < 0.05). No significant differences were seen between pediatricians from podcast and synopsis group.

Conclusions: NASPGHAN-ESPGHAN GER guidelines have a good applicability, despite they are currently poorly adhered to by European primary care pediatricians. Simple, inexpensive trainings were proven to be effective in increasing adherence by pediatricians. The increase in compliance clearly favors the role of continuous medical education through simple educational tools and subsequent assessment of practice.

(C) 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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