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European Pediatricians’ Approach to Children With GER Symptoms: Survey of the Implementation of 2009 NASPGHAN-ESPGHAN Guidelines

Quitadamo, Paolo*; Papadopoulou, Alexandra; Wenzl, Tobias; Urbonas, Vaidotas§; Kneepkens, C.M. Frank||; Roman, Enriqueta; Orel, Rok#; Pavkov, Danijela Jojkić**; Dias, Jorge Amil††; Vandenplas, Yvan‡‡; Kostovski, Aco§§; Miele, Erasmo*; Villani, Alberto||||; Staiano, Annamaria*

Journal of Pediatric Gastroenterology and Nutrition: April 2014 - Volume 58 - Issue 4 - p 505–509
doi: 10.1097/MPG.0b013e3182a69912
Original Articles: Gastroenterology

Objective: The aim of this study was to evaluate the current implementation of the 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines, and to assess proton pump inhibitors’ (PPIs) prescribing patterns among pediatricians from different European countries.

Methods: A randomly identified sample of general pediatricians distributed across 11 European countries. They were asked to complete a case report–structured questionnaire investigating their approaches to infants, children, and adolescents with symptoms suggestive of gastroesophageal reflux.

Results: A total of 567 European general pediatricians completed the study questionnaire. Only 1.8% of them showed complete adherence to the guidelines. Forty-six percent of them reported that they diagnose gastroesophageal reflux disease based on clinical symptoms irrespective of the age of the child; 39% prescribe PPIs in infants with unexplained crying and/or distressed behavior and 36% prescribe PPIs in infants with uncomplicated recurrent regurgitation and vomiting; 48% prescribed PPIs in children younger than 8 to 12 years with vomiting and heartburn, without specific testing; 45% discontinue PPI therapy abruptly rather than tapering the dose. The overall rate of pediatricians overprescribing PPIs was 82%.

Conclusions: The overall results of our survey show that the majority of pediatricians are unaware of 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition reflux guidelines and often prescribe PPIs despite a lack of efficacy for the symptoms being treated. The overdiagnosis of gastroesophageal reflux disease places undue burden on both families and national health systems, which has not been affected by the publication of international guidelines.

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*Department of Pediatrics, University “Federico II,” Naples, Italy

First Department of Pediatrics, University of Athens, Athens Children's Hospital “Agia Sophia,” Athens, Greece

Klinik für Kinder- und Jugendmedizin Universitätsklinikum, Aachen, Germany

§Vilnius University Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania

||Free University Medical Center, Amsterdam, The Netherlands

Department of Pediatrics, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

#Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital, University Medical Centre, Ljubljana, Slovenia

**Department of Pediatrics, Institute for Child and Youth Health Care of Vojvodina, Medical Facility Novi Sad, Serbia

††Department of Pediatrics, Hospital S. João, Alameda, Portugal

‡‡UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium

§§University Children's Hospital, Skopje, Macedonia

||||Ospedale Pediatrico Bambino Gesù, Rome, Italy.

Address correspondence and reprint requests to Annamaria Staiano, MD, Department of Pediatrics, University Federico II, Via S. Pansini, 5, 80131 Naples, Italy (e-mail:

Received 13 March, 2013

Accepted 18 July, 2013

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The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,