title: European pediatricians' approach to children with GER symptoms: survey of the implementation of 2009 NASPGHAN-ESPGHAN guidelines.
abstract: OBJECTIVE
  The aim of this study was to evaluate the current implementation of the 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines, and to assess proton pump inhibitors' (PPIs) prescribing patterns among pediatricians from different European countries.
  
  
  METHODS
  A randomly identified sample of general pediatricians distributed across 11 European countries. They were asked to complete a case report-structured questionnaire investigating their approaches to infants, children, and adolescents with symptoms suggestive of gastroesophageal reflux.
  
  
  RESULTS
  A total of 567 European general pediatricians completed the study questionnaire. Only 1.8% of them showed complete adherence to the guidelines. Forty-six percent of them reported that they diagnose gastroesophageal reflux disease based on clinical symptoms irrespective of the age of the child; 39% prescribe PPIs in infants with unexplained crying and/or distressed behavior and 36% prescribe PPIs in infants with uncomplicated recurrent regurgitation and vomiting; 48% prescribed PPIs in children younger than 8 to 12 years with vomiting and heartburn, without specific testing; 45% discontinue PPI therapy abruptly rather than tapering the dose. The overall rate of pediatricians overprescribing PPIs was 82%.
  
  
  CONCLUSIONS
  The overall results of our survey show that the majority of pediatricians are unaware of 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition reflux guidelines and often prescribe PPIs despite a lack of efficacy for the symptoms being treated. The overdiagnosis of gastroesophageal reflux disease places undue burden on both families and national health systems, which has not been affected by the publication of international guidelines.
authors.affiliation: *Department of Pediatrics, University "Federico II," Naples, Italy †First Department of Pediatrics, University of Athens, Athens Children's Hospital "Agia Sophia," Athens, Greece ‡Klinik für Kinder- und Jugendmedizin Universitätsklinikum, Aachen, Germany §Vilnius University Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania ||Free University Medical Center, Amsterdam, The Netherlands ¶Department of Pediatrics, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain #Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital, University Medical Centre, Ljubljana, Slovenia **Department of Pediatrics, Institute for Child and Youth Health Care of Vojvodina, Medical Facility Novi Sad, Serbia ††Department of Pediatrics, Hospital S. João, Alameda, Portugal ‡‡UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium §§University Children's Hospital, Skopje, Macedonia ||||Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Quitadamo
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papadopoulou
authors.forename: Tobias
authors.initials: T
authors.lastname: Wenzl
authors.forename: Vaidotas
authors.initials: V
authors.lastname: Urbonas
authors.forename: C M Frank
authors.initials: CM
authors.lastname: Kneepkens
authors.forename: Enriqueta
authors.initials: E
authors.lastname: Roman
authors.forename: Rok
authors.initials: R
authors.lastname: Orel
authors.forename: Danijela Jojkić
authors.initials: DJ
authors.lastname: Pavkov
authors.forename: Jorge Amil
authors.initials: JA
authors.lastname: Dias
authors.forename: Yvan
authors.initials: Y
authors.lastname: Vandenplas
authors.forename: Aco
authors.initials: A
authors.lastname: Kostovski
authors.forename: Erasmo
authors.initials: E
authors.lastname: Miele
authors.forename: Alberto
authors.initials: A
authors.lastname: Villani
authors.forename: Annamaria
authors.initials: A
authors.lastname: Staiano
mesh_terms: D002648:Child; D003448:Crying; D005060:Europe; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006356:Heartburn / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007223:Infant; D057045:Laryngopharyngeal Reflux / Q000188:drug therapy / Q000209:etiology; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D011795:Surveys and Questionnaires; D014839:Vomiting / Q000188:drug therapy / Q000209:etiology
chemical_list: D054328:Proton Pump Inhibitors