Gastroesophageal Reflux Treatment

Gastroesophageal Reflux Treatment
Q:
Gastroesophageal Reflux Treatment

Dr. Greene, our pediatrician prescribed Propulsid and Zantac for a case of infant reflux. My baby is only six weeks old. I’m concerned about any possible side effects. Is this a common prescription for infants diagnosed with reflux? Are there other alternative treatments?
Hamoon J. Hedayat – Director – Informix Software, Inc. – Rockville, Maryland

A:

Dr. Greene’s Answer:

Your concerns are quite valid. At the time of your question, Propulsid and Zantac were two of the most commonly used prescriptions for babies with reflux – even though neither of them had been approved for this use by the FDA. Later research led to one of one of them gaining approval after being shown to be safe and effective. The other was recalled, after being found to be dangerous.

I’ll answer your question about side effects, discuss other treatment options, and address the important issue of using drugs that have not been approved by the FDA for children. But first a few words about reflux itself.

How do you spell relief?

If you’ve ever experienced heartburn or acid indigestion, you are familiar with the dull, burning ache produced when acid sloshes up out of the stomach into the esophagus. This sloshing is called gastroesophageal reflux.

Babyhood is a time of spit-upping. Since the sphincter at the top of the stomach is often loose, many babies spit up milk out of their mouths or noses. In otherwise healthy, happy babies who are growing well, the spit-up is mostly milk, rather than stomach acid, and nothing needs to be done (except a lot of laundry!).

In some babies, though, the acid makes the lining of the esophagus tender, red, and swollen. They might arch their backs in pain. The acid can also be inhaled into the lungs, irritating their sensitive linings. These children might not gain weight well, or might cry and cry from discomfort. Some might develop a chronic cough, wheezing, hoarse voice, or recurrent pneumonia. A few even stop breathing (apnea) to try to protect their lungs. All of these children deserve some relief from their reflux.

Usually the first place to start is with looking at how the baby is fed. Decreasing the volume and increasing the frequency of feedings is sometimes enough to deal with reflux. If the baby is already drinking from a bottle, thickening the feedings with rice cereal is an option to be discussed with your physician. This can mechanically reduce the amount of milk sloshed back up the esophagus. Some studies suggest that this decreases both spitting up and crying in babies with reflux. However, this does provide extra calories to your baby, and it may also make it harder for your baby to know when he or she has had enough to eat.

Food allergies may also cause reflux. The most common culprits are cow’s milk and soy proteins in formulas. Foods in mother’s diet can also affect breastfeeding babies. Cow’s milk is the most common cause of this, but other foods such as soy, egg, and peanuts could also be a problem. For most babies, I prefer briefly trying to feed the baby without these exposures to see if this solves the reflux problem before trying any medication. I s