The National Institute for Health and Care Excellence (NICE) recently published draft guidelines on helping reduce unnecessary treatment for babies suffering from reflux.
In its proposals, the NHS watchdog highlighted the difficulty of diagnosing reflux disease in the paediatric population.
Gastro-oesophageal reflux (GOR), the regurgitation of milk into the oesophagus, can be a normal physiological process – indeed, effortless regurgitation of feeds can affect up to 40 per cent of infants under one.
But in some infants and young children, this reflux is not ‘normal’ and requires management or treatment – 13 per cent of youngsters aged up to 18 months are affected by gastro-oesophageal reflux disease (GORD).
Assessing whether a condition is serious enough to warrant treatment or a referral can be a worrying and stressful process. Distinguishing whether a condition is GOR or GORD can be incredibly difficult and it’s never easy to obtain a formal symptom history with infants.
International guidelines propose using invasive diagnostic tools such as 24-hour pH monitoring test and an acid sensor test – techniques that are understandably very stressful to babies, infants, children, as well as their parents and guardians.
At RD Biomed, we’ve been researching reflux disease since 1981 and in the 90s we began to focus on using salivary pepsin as a sensitive and specific marker for GORD.
Pepsin is the enzyme responsible for digestion and is only found in the stomach. So if pepsin is found outside the stomach, such as in the oesophagus, the throat, the mouth, the lungs or ears, then we know it has been refluxed.
We are currently running clinical studies to investigate the use of our saliva diagnostic test Peptest with children so we can bring a simpler and quicker method of diagnosis and prevent the trauma of more invasive techniques such as endoscopy.
It is so essential to distinguish mild issues from pathological disease before initiating a treatment programme – especially when it comes to babies and children.
When we provide feedback to the NICE proposed guidelines, we will share information of our ongoing work with Boston Children’s Hospital in Massachusetts, Manchester Royal Infirmary and Barts and The London School of Medicine and Dentistry in London.
NICE’s ‘Gastro-oesophageal reflux in children and young people’ document is open for consultation until 25 September 2014, with final guidance published later in the year.