title: Gastroesophageal reflux disease: exaggerations, evidence and clinical practice.
abstract: OBJECTIVE
  there are many questions and little evidence regarding the diagnosis and treatment of gastroesophageal reflux disease (GERD) in children. The association between GERD and cow's milk protein allergy (CMPA), overuse of abdominal ultrasonography for the diagnosis of GERD, and excessive pharmacological treatment, especially proton-pump inhibitors (PPIs) are some aspects that need clarification. This review aimed to establish the current scientific evidence for the diagnosis and treatment of GERD in children.
  
  
  METHODS
  a search was conducted in the MEDLINE, PubMed, LILACS, SciELO, and Cochrane Library electronic databases, using the following keywords: gastroesophageal reflux; gastroesophageal reflux disease; proton-pump inhibitors; and prokinetics; in different age groups of the pediatric age range; up to May of 2013.
  
  
  RESULTS
  abdominal ultrasonography should not be recommended to investigate gastroesophageal reflux (GER). Simultaneous treatment of GERD and CMPA often results in unnecessary use of medication or elimination diet. There is insufficient evidence for the prescription of prokinetics to all patients with GER/GERD. There is little evidence to support acid suppression in the first year of life, to treat nonspecific symptoms suggestive of GERD. Conservative treatment has many benefits and with low cost and no side-effects.
  
  
  CONCLUSIONS
  there have been few randomized controlled trials that assessed the management of GERD in children and no examination can be considered the gold standard for GERD diagnosis. For these reasons, there are exaggerations in the diagnosis and treatment of this disease, which need to be corrected.
authors.affiliation: Pediatric Gastroenterology Service, Hospital da Criança Santo Antônio, Complexo Hospitalar Santa Casa, Porto Alegre, RS, Brazil; Pediatrics Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil; Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil. Electronic address: cristinatarga@terra.com.br.
authors.forename: Cristina Targa
authors.initials: CT
authors.lastname: Ferreira
authors.affiliation: Pediatrics Unit, Hospital de Base do Distrito Federal, DF, Brazil; Hospital da Criança de Brasília, DF, Brazil; Centro Universitário de Brasília, DF, Brazil; Pediatric Gastroenterology Department, Sociedade Brasileira de Pediatria, Brasília, DF, Brazil.
authors.forename: Elisa de
authors.initials: Ed
authors.lastname: Carvalho
authors.affiliation: Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pediatrics Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Vera Lucia
authors.initials: VL
authors.lastname: Sdepanian
authors.affiliation: Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pediatrics Department, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Clínica de Especialidades Pediátricas, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
authors.forename: Mauro Batista de
authors.initials: MB
authors.lastname: Morais
authors.affiliation: Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pediatrics Department, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil; Pediatric Gastroenterology Service, Hospital Pequeno Príncipe, Curitiba, PR, Brazil; Hospital da Criança de Brasília, DF, Brazil.
authors.forename: Mário César
authors.initials: MC
authors.lastname: Vieira
authors.affiliation: Gastroenterology Department, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pediatrics Gastroenterology and Hepatology Service, Universidade Federal da Bahia, Salvador, BA, Brazil; Academia Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil.
authors.forename: Luciana Rodrigues
authors.initials: LR
authors.lastname: Silva
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D050782:Esophageal pH Monitoring; D055317:Evidence-Based Practice; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D016269:Milk Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D008894:Milk Proteins / Q000009:adverse effects; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D006635:Histamine H2 Antagonists; D008894:Milk Proteins; D054328:Proton Pump Inhibitors
keywords: Child; Criança; Doença do refluxo gastroesofágico; Gastroesophageal reflux; Gastroesophageal reflux disease; Infant; Inibidores da bomba de prótons/uso terapêutico; Inibidores de bomba de prótons; Lactente; Proton pump inhibitors; Proton pump inhibitors/therapeutic use; Refluxo gastroesofágico