Do pediatricians apply the 2009 NASPGHAN-ESPGHAN guidelines for the diagnosis and management of gastroesophageal reflux after being trained?
BACKGROUND
According to a recent survey, the 2009 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition gastroesophageal reflux guidelines are poorly adhered to by European primary care pediatricians. The main issue raised from the survey was the prescription of unnecessary acid suppressive medications, especially in infants. No inquiry into the reasons was made. The primary objective of the present study was to assess the applicability of the guidelines in European primary care pediatricians undergoing specific trainings.


METHODS
One hundred pediatricians involved in the previous survey agreed to participate and were randomly divided into 2 groups: one group was trained in the guidelines through an online podcast and the other group was trained through a synopsis. During the following 3 months, each involved pediatrician was asked to enroll every consecutive infant, child, or adolescent with suggestive reflux symptoms. For every enrolled patient, pediatricians filled in a report concerning their diagnostic and therapeutic choices.


RESULTS
A total of 382 patients (boys/girls 186/196, infants/children/adolescents 194/123/65) were enrolled by pediatricians. Infants with unexplained crying and/or distressed behavior who were prescribed proton-pump inhibitors were 3.7% compared with 45.2% of the survey data obtained before the training (P < 0.05). Infants with uncomplicated recurrent regurgitation and vomiting who were prescribed proton-pump inhibitors were 4.5% against 37.1% of the baseline survey data (P < 0.05). The overall rate of children managed in full compliance with the guidelines was 46.1% after the training compared with 1.8% before the training (P < 0.05). No significant differences were seen between pediatricians from podcast and synopsis group.


CONCLUSIONS
The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition-European Society for Pediatric Gastroenterology, Hepatology, and Nutrition gastroesophageal reflux guidelines have good applicability, despite that they are presently poorly adhered to by European primary care pediatricians. Simple, inexpensive trainings were proven to be effective in increasing adherence by pediatricians. The increase in compliance clearly favors the role of continuous medical education through simple educational tools and subsequent assessment of practice.
*Department of Translational Medical Science, Section of Pediatrics, University "Federico II," Naples, Italy †Vilnius University Clinic of Children's Diseases, Vilnius University, Vilnius, Lithuania ‡First Department of Pediatrics, University of Athens, Athens Children's Hospital "Agia Sophia," Athens, Greece §Department of Pediatrics, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain ||Department of Pediatrics, Institute for Child and Youth Health Care of Vojvodina, Medical Faculty Novi Sad, Novi Sad, Serbia ¶Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital, University Medical Centre, Ljubljana, Slovenia #Department of Pediatrics, Hospital S João, Alameda, Portugal **University Children's Hospital, Skopje, Macedonia ††Ospedale Pediatrico Bambino Gesù, Rome, Italy.
Paolo
P
Quitadamo
Vaidotas
V
Urbonas
Alexandra
A
Papadopoulou
Enriqueta
E
Roman
Danijela J
DJ
Pavkov
Rok
R
Orel
Jorge A
JA
Dias
Aco
A
Kostovski
Erasmo
E
Miele
Alberto
A
Villani
Annamaria
A
Staiano
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004502:Education, Medical, Continuing / Q000379:methods*; D005060:Europe; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000592:standards*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
D054328:Proton Pump Inhibitors