Gastro-oesophageal reflux disease in children and young people: diagnosis and management

Sleeping position

Evidence suggested that reflux may be reduced in infants in lateral sleeping positioning, which was consistent with evidence considered when developing the guideline. However, the committee did not recommend lateral positioning because it thought that government advice on placing infants on their back should be followed because it reduces the risk of sudden infant death syndrome.

Alginates and feed thickeners

One small study suggested that alginate was more effective than feed thickeners for reducing reflux, and feed thickeners were more effective than advice and lifestyle changes. The order of interventions recommended in the guideline is firstly advice and lifestyle changes, followed by feed thickeners, and then alginate. The new evidence was considered to be insufficient to trigger an update to reassess the order of these interventions, which were made on the basis that the least intrusive and cheaper options should be offered first. New evidence was insufficient to guide the choice of specific feed thickeners.

Proton pump inhibitors

New evidence on effectiveness and safety of proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H₂RAs) generally supports current guidance. Evidence suggests a substantial risk of overdose with ranitidine in children, which the report noted may be due to a liquid formulation with a high concentration of ranitidine. NICE guidelines assume that prescribers will use a medicine's summary of product characteristics (SPC), the British National Formulary (BNF) and the BNF for children to inform decisions made with individual patients. The evidence reinforces the need to follow the SPC carefully, but has no direct impact on using ranitidine in children.

Enteral feeding and surgery

New evidence on enteral feeding and surgery for GORD suggests that both treatments may be effective. The findings support current recommendations for enteral feeding in children with faltering growth associated with overt regurgitation and fundoplication for children with severe intractable GORD.

Premature babies and neurodisability

Topic expert feedback indicated that further guidance was needed on interventions suitable for premature babies and children with neurodisability. Few new studies in these populations were identified and the new evidence was insufficient to inform new recommendations.

For further details and a summary of all evidence identified in surveillance, see appendix A.