Colic, or Gastroesophageal Reflux: Over-Diagnosed and Over-Treated

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The consequences of current treatments for the disease, which occurs when stomach acid flows back into the esophagus, outweigh the benefits

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Infants cry, some more than others, some more alarmingly than others. Some infants go through a period of "colic" which is excessive and unexplained crying often accompanied by body arching and inability to be soothed. Colic generally resolves by about four months. The causes of colic are unknown and may be related to infant temperament, parenting practices, and food intolerances.

It is understandable that parents of such infants feel desperate for relief of their baby's discomfort. But doctors may be too willing to prescribe acid-reducing medication for these infants, according to a recent commentary in The Journal of Pediatrics. The medications are the same sort that adults with gastroesophageal reflux disease (GERD) are given.

Gastroesophageal reflux disease (GERD) is a chronic digestive disease that occurs when stomach acid flows back into the esophagus. This backwash of acid irritates the lining of your esophagus. The symptoms of GERD include acid reflux, heartburn, and chest and abdominal discomfort. Often diagnosed in the adult population, GERD has been increasingly identified as a reason for spitting and irritability in young infants.

In his commentary, Eric Hassall, a pediatric gastroenterologist, makes the point that there is an epidemic of over-diagnosis and over-medication of gastroesophageal reflux disease in young infants. He is concerned because he believes that unnecessary treatment with acid-suppressing medications has negative consequences for babies and that the risks, in most cases, far outweigh the benefits. He makes a compelling case.

COLIC IS NOT REFLUX

Colic, says Hassall, is not a sign of acid reflux and should not be treated as such. In some infants, excessive crying and apparent abdominal discomfort is more likely to be a transient intolerance to lactose or some other component of the infant's or breast-feeding mother's diet causing excessive gas production and abdominal pain.

"We are medicalizing normality," Hassall asserts. An elimination diet, in which foods are systematically eliminated to determine which might be contributing to the colic is the recommended treatment for such issues, not acid-suppressing medication.

The most commonly used drugs to treat acid reflux in children are proton pump inhibitors (PPIs) that prevent the secretion of acid by gastric cells. Some brand names of proton pump inhibitors include Prilosec, Prevacid, Nexium, and Protonix. While they have been considered generally safe, long-term use of acid-suppressing medications is not without concerns. Some older children and adults develop gastric polyps when taking them and most patients develop rebound hyperacidity symptoms when they are discontinued abruptly.

The acidity of one's stomach juices is considered to be a line of defense against infections and decreasing this acid level may leave the patient more vulnerable to infectious problems. Increases in both gastrointestinal infections and pneumonias have been seen in children and adults who take acid suppressors. In adults, there is also concern that use of acid-suppressing medications may contribute to increases in food allergies, changes in calcium absorption, development of fractures, and the possibility of interstitial nephritis, a kidney condition.

THINGS TO TRY FIRST

When an otherwise healthy infant appears to be crying and spitting excessively, Hassall suggests an in-depth medical consultation, conservative treatment measures, and the tincture of time. He recommends that the baby's health care provider and parents carefully review the history of the baby's symptoms. The more specific the information, the more likely a pattern will emerge that parents and health care providers can use to create an informed approach to ease the stress and discomfort on infant and family.

Some areas to explore include: Could the baby be drinking too much at a time? Would spacing out feeds make a difference? Is the baby being properly burped and positioned after feeding? When does the crying seem to occur? What helps? What makes it worse? Does it seem to follow a pattern? What do the parents think is wrong?

When a dietary intolerance is suspected, the family can change formulas under medical supervision and the breastfeeding mother can eliminate likely offenders from her diet and gradually experiment with adding them back in as the baby's gastrointestinal system matures.

If the infant appears to meet the criteria for classic colic, various soothing and coping techniques can be recommended for both the infant and the family.

If the infant fails to respond to conservative measures and gastroesophageal reflux disease is suspected, acid-suppressing medications can be tried for a short trial period. But according to Hassall, "ongoing treatment needs to be earned by repeated attempts at weaning off medication."

While there are clearly some infants with true GERD who will benefit from acid-suppressing medications, these infants must be more carefully identified and monitored through treatment in order to change the current PPI over prescription epidemic.

Image: Rehan Qureshi/Shutterstock.


This article originally appeared on TheDoctorWillSeeYouNow.com, an Atlantic partner site.

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Esther Entin, M.D., is a pediatrician and clinical associate professor of Family Medicine at Brown University's Warren Alpert School of Medicine. She writes for TheDoctorWillSeeYouNow.com.

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