Regurgitation

Regurgitation

For each infant trouble or a combination of troubles,
Novalac offers an adapted nutritional solution.

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

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 vomiting 1.  

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.

Regurgitations are the most common functional gastro-intestinal disorders (FGIDs) in the first year of life: when diagnosed according to Rome IV criteria, their prevalence ranged from 13.8% in a European multicenter cross-sectional study 3 to 41% based on a French multicenter cross-sectional study 4. Although more frequent in neonates and young infants than in older infants, regurgitations can occur at any age. Epidemiological studies suggest that GER persists after 12 months of age in about 10% of infants 5,6.

Regurgitation is a normal physiologic process often occurring in the postprandial period, few times per day in healthy infants, children and adults 5.However, repeated episodes of regurgitation of large volumes can lead to complications or contribute to tissue damage or inflammation 1. When GER leads to troublesome symptoms and impact significantly the quality of life of the infant and parents, it is considered as pathologic and called gastro-esophageal reflux disease (GERD) 1,7. Failure to thrive or poor weight gain can be the result of recurrent regurgitation and is a warning sign of GERD 8.

Experts recommend thickened feeds for treating visible regurgitation/vomiting, including infants with GERD 1.

  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. J. Pediatr. Gastroenterol. Nutr. 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. J. Pediatr. Gastroenterol. Nutr. 61, 531–537 (2015).
  3. Steutel, N. et al. Prevalence of Functional Gastrointestinal Disorders in European Infants and Toddlers. J. Pediatr. 221, 107–114 (2020).
  4. Campeotto, F., Barbaza, M.-O. & Hospital, V. Functional Gastrointestinal Disorders in Outpatients Aged up to 12 Months: A French Non-Interventional Study. Int. J. Environ. Res. Public. Health 17, (2020).
  5. Quitadamo, P. & Staiano, A. Clinical Picture of Gastroesophageal Reflux Disease in Children. Gastroesophageal Reflux Dis. – Theory Res. (2019) doi:10.5772/intechopen.82453.
  6. Poddar, U. Diagnosis and management of gastroesophageal reflux disease (GERD): An indian perspective. Indian Pediatr. (2013) doi:10.1007/s13312-013-0036-x.
  7. Vandenplas, Y. et al. Infant gastroesophageal reflux disease management consensus. Acta Paediatr. Oslo Nor. 1992 113, 403–410 (2024).
  8. Czinn, S. J. & Blanchard, S. Gastroesophageal reflux disease in neonates and infants : when and how to treat. Paediatr. Drugs 15, 19–27 (2013).

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.