title: Efficacy of conservative therapy as taught in the primary care setting for symptoms suggesting infant gastroesophageal reflux.
abstract: OBJECTIVE
  To determine the efficacy of non-pharmacologic conservative therapy for infant gastroesophageal reflux disease (GERD).
  
  
  METHODS
  Consenting parents of the first 50 screened infants who met inclusion/exclusion criteria including abnormal (>16/42) scores on the Infant Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R; n = 40) were taught conservative therapy measures by each site's study nurse: feeding modifications, positioning, and tobacco smoke avoidance. We compared I-GERQ-R scores and symptom response details before and 2 weeks after institution of these measures with 2-tail Wilcoxon signed ranks test in the 37 infants (age range, 4-43 weeks; median age, 13 weeks) who completed the run-in.
  
  
  RESULTS
  The median initial and final scores were 23 (16-36) and 18 (7-34; P < .000001). The median score change was -5 (+6--16). Scores of 78% improved at all; 59% improved at least the threshold of 5 points; 24% became normal. Scores for individual symptoms related to regurgitation, crying, and arching improved significantly.
  
  
  CONCLUSIONS
  Two weeks of conservative therapy measures taught in primary care improved 59% beyond the 5-point threshold and normalized 24% of infants with symptom severity diagnostic for GERD, as substantiated with a responsiveness-validated instrument.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Orenstein
authors.forename: John D
authors.initials: JD
authors.lastname: McGowan
mesh_terms: D000284:Administration, Oral; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D005745:Gastric Acidity Determination; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000379:methods; D011320:Primary Health Care / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D006635:Histamine H2 Antagonists