Regurgitation

Regurgitation

For each infant trouble, Novalac offers an adapted nutritional solution.

Regurgitations are the effortless returns of gastric contents through the esophagus and out of the mouth.

Gastro-esophageal reflux (GER) is defined as the passage of gastric content into the esophagus with or without regurgitation and vomiting1. This may cause acid exposure, at the origin of burning sensations.

In literature, the prevalence of regurgitations in infants younger than 12 months varies from 3 % to 87%2, this large range being probably due to differences across studies in their design, their setting, and the diagnosis criteria used. According to a recent study using the Rome IV criteria as definition for regurgitations, the reported prevalence was of 24.1%3. In a French cross-selectional study, the estimated prevalence of GER in infants aged from 0 to 23 months was 24.4%, and that in children aged from 2 to 11 years was 7.2%4.

Regurgitations can be physiologic and can be aggravated through several factors: lying position, abdominal compression, important volume of feeding, liquid foods. They can also be a symptom of another disease such as cow’s milk allergy5.

When GER leads to more severe symptoms that affect daily functioning and/or complications, it is called GER Disease (GERD). High volumes of regurgitations returned with force may lead to other important issues like feeding difficulties, growth disorders, etc1.

Experts recommend thickened feed for treating visible regurgitation/vomiting, including infants with GERD1.

  1. Rosen R., et al., Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. JPGN 66: 516–554 (2018).
  2. Vandenplas Y., et al., Prevalence and Health Outcomes of Functional Gastrointestinal Symptoms in Infants From Birth to 12 Months of Age. JPGN 61: 531–537 (2015).
  3. Robin S. G., et al. Prevalence of Pediatric Functional Gastrointestinal Disorders Utilizing the Rome IV Criteria. J. Pediatr. 195, 134–139 (2018).
  4. Martigne L., et al. Prevalence and management of gastroesophageal reflux disease in children and adolescents: a nationwide cross-sectional observational study. Eur. J. Pediatr. 171, 1767–1773 (2012).
  5. Salvatore S., & Vandenplas,Y., Gastroesophageal reflux and cow milk allergy: is there a link? Pediatrics 110, 972–984 (2002)

Clinical trials and studies

The efficacy of Novalac formulas is evidenced in published clinical trials. Amongst them are some of the largest studies ever performed to date on anti-regurgitation formulas, extensively hydrolyzed formulas, and elemental (amino-acid) formulas.

2016

Efficacy and tolerance

Efficacy and tolerance of a new anti-regurgitation formula

Pediatric Gastroenteroly, Hepatology & Nutrition, 2016, 19(2):104-9

Dupont C, Vandenplas Y; SONAR Study Group

Regurgitation is a common physiological phenomenon in infants. The aim of the present study was to evaluate the efficacy of a new anti-regurgitation (AR) formula (Novalac), thickened with an innovative complex including fibres, on the daily number of regurgitations and to assess its impact on stool consistency and frequency.

2013

Comparative cross-over trial

Double-blind comparative trial with 2 antiregurgitation formulae

Journal of Pediatric Gastroenterology and Nutrition, 2013, 57(3):389-93

Vandenplas Y, Leluyer B, Cazaubiel M, Housez B, Bocquet A

Many mothers consult physicians because of frequent infant regurgitation. Guidelines recommend reassurance and dietary treatment as first approaches. The aim of the present study was to test and compare the efficacy of 2 antiregurgitation formulae (ARF).

2008

Prevalence of GI disorders – Efficacy in management

Prevalence and dietetic management of mild gastrointestinal disorders in milk-fed infants

World Journal of Gastroenterology, 2008, 14(2):248-54

Infante Pina D, Badia Llach X, Ariño-Armengol B, Villegas Iglesias V

The aim is to assess the prevalence of mild gastrointestinal disorders in milk-fed infants in paediatric practice, and to evaluate the effectiveness and satisfaction with dietetic treatment.

Comparative cross-over trial

A double-blinded, prospective trial with a new formula in distressed and regurgitating infants

The Open Nutrition Journal, 2008, 2:48-50

Vandenplas Y, Devreker T, Hauser B

Infant regurgitation and distress are common but are a major cause of parental anxiousness. The efficacy of dietary management is contradictory.

2007

Efficacy

Comparison of the effect of a cornstarch thickened formula and strengthened regular formula on regurgitation, gastric emptying and weight gain in infantile regurgitation

Diseases of the Esophagus, 2007, 20(2):155-60

Chao HC, Vandenplas Y

The purpose of this study was to evaluate the efficacy of a specially selected cornstarch-supplemented formula on clinical symptoms, gastric emptying and weight gain in infants with regurgitation.

We performed a prospective randomised trial evaluating the therapeutic efficacy of two different formula feedings (cornstarch-thickened formula, group A; 25% strengthened formula, group B) in 81 young infants with regurgitation/vomiting > or = 3 times/day. A Tc-99 m milk scintigraphy was performed at inclusion and after 2 months to quantify gastric emptying time; all studied infants underwent a 2-month period of clinical follow-up evaluating regurgitation and body weight gain. At inclusion, group A and B had a similar age and weight (…).

2005

Acid exposure

Cornstarch thickened formula reduces oesophageal acid exposure time in infants

Digestive and Liver Disease, 2005, 37(1):23-7

Xinias I, Mouane N, Le Luyer B, Spiroglou K, Demertzidou V, Hauser B, Vandenplas Y

Infant regurgitation is a phenomenon causing worldwide parental distress and anxiety. Parental reassurance and dietary advices regarding feeding techniques and volumes are helpful in the management. Guidelines also recommend the use of thickened formula. However, the impact of thickened feeding on the frequency of acid reflux is still a matter of debate. Therefore, we evaluated the effect of a casein predominant formula thickened with a specifically selected and treated cornstarch on the frequency and duration of acid reflux episodes.