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Acid suppressants for managing gastro-oesophageal reflux and gastro-oesophageal reflux disease in infants: a national survey
  1. Jane C Bell1,
  2. Francisco J Schneuer1,
  3. Christopher Harrison1,
  4. Lyndal Trevena2,
  5. Harriet Hiscock3,
  6. Adam G Elshaug1,
  7. Natasha Nassar1
  1. 1 Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  2. 2 Discipline of General Practice, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  3. 3 Centre for Community Child Health, The Royal Children’s Hospital and The Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
  1. Correspondence to Dr Jane C Bell, Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia; jane.bell{at}sydney.edu.au

Abstract

Objectives To evaluate the diagnosis and management of reflux and gastro-oesophageal reflux disease (GORD) in infants aged <1 year presenting to general practitioners (GPs).

Design, setting and participants A nationally representative, prospective, cross-sectional survey of GP activity in Australia, 2006–2016 (Bettering the Evaluation And Care of Health Study). Annually, a random sample of around 1000 GPs recorded details for 100 consecutive visits with consenting, unidentified patients.

Outcome measures Diagnoses of reflux and GORD and their management including prescribing of acid-suppressant medicines (proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs)) and counselling, advice or education.

Results Of all infants’ visits, 512 (2.7%) included a diagnosis of reflux (n=413, 2.2%) or GORD (n=99, 0.5%). From 2006 to 2016, diagnostic rates decreased for reflux and increased for GORD. Prescribing of acid suppressants occurred in 43.6% visits for reflux and 48.5% visits for GORD, similar to rates of counselling, advice or education (reflux: 38.5%, GORD: 43.4% of visits). Prescribing of PPIs increased (statistically significant only for visits for reflux), while prescribing of H2RAs decreased.

Conclusions Overprescribing of acid suppressants to infants may be occurring. In infants, acid-suppressant medicines are no better than placebo and may have significant negative side effects; however, guidelines are inconsistent. Clear, concise and consistent guidance is needed. GPs and parents need to understand what is normal and limitations of medical therapy. We need a greater understanding of the influences on GP prescribing practices, of parents’ knowledge and attitudes and of the pressures on parents of infants with these conditions.

  • gastroenterology
  • general practice
  • general paediatrics
  • health services research
  • infants

https://doi.org/10.1136/archdischild-2017-314161

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    Footnotes

    • Contributors JCB contributed to study design, prepared and analysed the data, interpreted results and drafted the manuscript. FJS conceived the study and contributed to study design and contributed to data interpretation. CH contributed to data preparation and analysis and interpreted the results. LT, HH and AGE contributed to data interpretation. NN conceived the study and contributed to study design, coordinated and supervised data analysis and interpretation.

    • Funding Between April 2006 and March 2016, the BEACH program was funded by the Australian Government Department of Health, the Australian Government Department of Veterans’ Affairs, AstraZeneca (Australia), Novartis Pharmaceuticals Australia, Seqirus Australia, AbbVie, Merck Sharp & Dohme (Australia), Pfizer Australia, GlaxoSmithKline Australia, Sanofi-Aventis Australia, Bayer Australia, Janssen-Cilag, Abbott Australasia, Wyeth Australia, Roche Products and the National Prescribing Service. The Murdoch Children’s Research Institute is supported by the Victorian Government’s Operational Infrastructure Program. NN was supported by a National Health and Medical Research Council Career Development Fellowship (APP1067066). AGE receives salary support as the HCF Research Foundation Professorial Research Fellow and holds research grants from The Commonwealth Fund and Australia’s National Health and Medical Research Council (ID 1109626 and 1104136). He also receives consulting/sitting fees from Cancer Australia, the Capital Markets Cooperative Research Centre-Health Quality Program, NPS MedicineWise (facilitator of Choosing Wisely Australia), The Royal Australasian College of Physicians (facilitator of the EVOLVE program) and the Australian Commission on Safety and Quality in Health Care and as a member of the Australian Government Department of Health’s Medicare Benefits Schedule Review Taskforce. HH was supported by an NHMRC Practitioner Fellowship (APP 1136222).

    • Competing interests None declared.

    • Ethics approval The BEACH program and associated studies were approved by the Human Research Ethics Committee of the University of Sydney (reference: 2012/130).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The BEACH Study data that support the findings of this study are available from the University of Sydney, but restrictions to access apply. For the current study, data were used under license and are not publicly available.