Ten-Year Trends in Pharmacologic Management of Gastroesophageal Reflux Disease and Pediatric Feeding Disorders in Young Children

Suzanna Hirsch; Enju Liu; Samuel Nurko; Rachel Rosen

doi:10.1016/j.jpeds.2025.114628

Ten-Year Trends in Pharmacologic Management of Gastroesophageal Reflux Disease and Pediatric Feeding Disorders in Young Children

J Pediatr. 2025 Apr 27:283:114628. doi: 10.1016/j.jpeds.2025.114628. Online ahead of print.

Authors

Suzanna Hirsch¹, Enju Liu², Samuel Nurko³, Rachel Rosen³

Affiliations

¹ Division of Gastroenterology, Hepatology & Nutrition, Aerodigestive Center, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA. Electronic address: suzanna.hirsch@childrens.harvard.edu.
² Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA.
³ Division of Gastroenterology, Hepatology & Nutrition, Aerodigestive Center, Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA.

PMID: 40300664
DOI: 10.1016/j.jpeds.2025.114628

Abstract

Objective: To evaluate 10-year trends in pharmacologic management of young children with gastroesophageal reflux disease (GERD) or pediatric feeding disorder (PFD), a population at risk for over prescribing.

Study design: Single-center, retrospective cohort study of children ≤2 years diagnosed with GERD or PFD between January 2014 and December 2023. Prescriptions were searched for proton pump inhibitors (PPI), H2-receptor antagonists (H2RA), cyproheptadine, erythromycin, metoclopramide, or prucalopride, and procedures were searched for intrapyloric botulinum injections. The change over time in the percent of patients with GERD or PFD prescribed each medication class was assessed using the Cochran-Armatage test for trend.

Results: There were 49 483 children ≤2 years diagnosed with GERD or PFD across all years, with an increasing number of patients seen annually (6516 in 2014 vs 9109 in 2023). The percent of patients receiving any prescription for GERD or PFD declined by almost 50%, from 36.5% in 2014 to 18.7% in 2023 (P < .001). There was a particular decline in PPI prescriptions, with 25.3% of patients receiving PPI in 2014 and 7.1% receiving PPI in 2023 (P < .001), and also a decline in H2RA prescriptions, with 17.0% of patients receiving H2RA in 2014 and 11.1% receiving H2RA in 2023 (P < .0001). Decreases over time also were seen in the percent of patients prescribed erythromycin (P = .045) and metoclopramide (P = .006), while there was an increase in the percent of patients prescribed cyproheptadine (P = .009) and prucalopride (P < .0001). Intrapyloric botulinum injections increased but remained infrequent.

Conclusions: In this large, single-center study, prescriptions for young children with GERD or PFD declined over this 10-year period. There were substantial declines in PPI prescribing, contrasting with prior studies. These trends may indicate growing alignment of practice with consensus recommendations that advise against acid suppression as first-line management in this population.

Keywords: acid suppression; gastroesophageal reflux disease (GERD); intrapyloric botulinum injection; pediatric feeding disorder (PFD); prokinetics; proton pump inhibitor (PPI).