Parents and carers ofneonatesandinfantsshould be
reassured that most symptoms of uncomplicated gastro-
oesophageal reflux resolve without treatment. An increase in
the frequency and a decrease in the volume of feeds may
reduce symptoms. A feed thickener or pre-thickened formula
feed can be used on the advice of a dietician. If necessary, a
suitable alginate-containing preparation can be used instead
of thickened feeds. A thickening agent should be tried for up
to 2 weeks before considering other treatment.
Older childrenshould be advised about life-style changes
such as weight reduction if overweight, and the avoidance of
alcohol and smoking. An alginate-containing antacid can be
used to relieve symptoms.
Children who do not respond to these measures or who
have problems such as respiratory disorders or suspected
oesophagitis need to be referred to hospital. On the advice of
a paediatrician, ahistamine H 2 -receptor antagonistcan be
used to relieve symptoms of gastro-oesophageal reflux
disease, promote mucosal healing and permit reduction in
antacid consumption. Aproton pump inhibitorcan be used
for the treatment of moderate, non-erosive oesophagitis that
is unresponsive to an H 2 - receptor antagonist.
Endoscopically confirmederosive,ulcerative,orstricturing
disease in children is usually treated with a proton pump
inhibitor. Reassessment is necessary if symptoms persist
despite 4 – 6 weeks of treatment; long-term use of an H 2 -
receptor antagonist or proton pump inhibitor should not be
undertaken without full assessment of the underlying
condition. For endoscopically confirmederosive,ulcerative,
orstricturingdisease, the proton pump inhibitor usually
needs to be maintained at the minimum effective dose.
Motility stimulants, such as erythromycin p. 331 may
improve gastro-oesophageal sphincter contraction and
accelerate gastric emptying. Evidence for the long-term
efficacy of motility stimulants in the management of gastro-
oesophageal reflux in children is unconvincing.
For advice on specialised formula feeds, see Enteral feeds.Pregnancy
If dietary and lifestyle changes fail to control gastro-
oesophageal reflux disease in pregnancy, an antacid or an
alginate can be used. If this is ineffective, ranitidine p. 54 can
be tried. Omeprazole p. 58 is reserved for women with severe
or complicated reflux disease.Other drugs used for Gastro-oesophageal reflux disease
Esomeprazole, p. 56 .Lansoprazole, p. 57ANTACIDS›ALGINATE
Sodium alginate with calcium
carbonate and sodium bicarbonate
The properties listed below are those particular to the
combination only. For the properties of the components
please consider, alginic acid p. 50 , sodium bicarbonate
p. 586 , calcium carbonate p. 592.lINDICATIONS AND DOSE
Mild symptoms of gastro-oesophageal reflux disease
▶BY MOUTH
▶Child 6–11 years: 5 – 10 mL, to be taken after meals and
at bedtime
▶Child 12–17 years: 10 – 20 mL, to be taken after meals and
at bedtimelINTERACTIONS→Appendix 1 : calcium salts.sodium
bicarbonate
lPRESCRIBING AND DISPENSING INFORMATIONFlavours of
oral liquid formulations may include aniseed or
peppermint.lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Gaviscon for gastro-oesophageal
reflux diseasewww.medicinesforchildren.org.uk/gaviscon-
gastro-oesophageal-reflux-diseaselMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Oral suspension
ELECTROLYTES:May contain Sodium
▶Sodium alginate with calcium carbonate and sodium bicarbonate
(Non-proprietary)
Calcium carbonate 16 mg per 1 ml, Sodium bicarbonate 26.7 mg
per 1 ml, Sodium alginate 50 mg per 1 mlAlginate raft-forming
oral suspension aniseed sugar-free| 500 mlGsDT = £ 1. 95
Alginate raft-forming oral suspension sugar-free| 500 mlGsDT
=£ 1. 95
Alginate raft-forming oral suspension peppermint sugar-free|
500 mlGsDT = £ 1. 95
▶Brands may include Acidex, Entrocalm Heartburn and Indigestion
Relief, Gaviscon, Gaviscon Cool, Gaviscon Liquid Relief, Peptac4.4 Helicobacter pyloridiagnosis
DIAGNOSTIC AGENTS
Urea (13C)
lINDICATIONS AND DOSE
Diagnosis of gastro-duodenalHelicobacter pyloriinfection
▶BY MOUTH
▶Child:(consult product literature)lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Soluble tablet
▶Pylobactell(Torbet Laboratories Ltd)
Urea [13-C] 100 mgPylobactell breath test kit| 1 kitP£ 20. 75
Powder
▶Helicobacter Test INFAI(INFAI UK Ltd)
Urea [13-C] 45 mgHelicobacter Test INFAI for children breath test kit
sugar-free| 1 kitP£ 19. 10
Urea [13-C] 75 mgHelicobacter Test INFAI breath test kit sugar-free
| 1 kitP£ 21. 70
Tablet
▶Diabact UBT(HFA Healthcare Products Ltd)
Urea [13-C] 50 mgdiabact UBT 50 mg tablets| 1 tabletP£ 21. 255 Food allergy
Food allergy 15-Dec-2016
Description of condition
Food allergy is an adverse immune response to a food,
commonly associated with cutaneous and gastro-intestinal
reactions, and less frequently associated with respiratory
reactions and anaphylaxis. It is distinct from food
intolerance which is non-immunological. Cow’s milk, hen’s
eggs, soy, wheat, peanuts, tree nuts,fish, and shellfish are
the most common allergens. Cross-reactivity between
similar foods can occur (e.g. allergy to other mammalian
milk in patients with cow’s milk allergy).Management of food allergy
gAllergy caused by specific foods should be managed by
strict avoidance of the causal food. Sodium cromoglicate
p. 167 is licensed as an adjunct to dietary avoidance in
children with food allergy. Educating the child or their carer
about appropriate nutrition, food preparation, and the risks60 Food allergy BNFC 2018 – 2019
Gastro-intestinal system1