{
  "abstract": "Proton pump inhibitors (PPIs) are frequently prescribed in paediatrics for symptoms suggestive of gastroesophageal reflux disease (GERD). Despite their therapeutic role, concerns remain regarding overuse, prolonged duration, and deviation from established guidelines. North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) 2018 guidelines suggest dietary and lifestyle modifications before pharmacological treatment, limiting omeprazole use to 4–8 weeks before reassessment, and referral to a paediatric gastroenterologist when symptoms persist or complications are suspected. This study aimed to assess compliance with these guidelines within a hospital trust in England.A retrospective review was conducted on 50 randomly selected paediatric patients who attended outpatient clinics and were prescribed omeprazole. Data were collected from electronic records with support from junior medical and pharmacy teams. Information included patient age, sex, clinical indication, duration and repetition of prescriptions, whether dietary modification was trialled before initiation, and whether the prescription was made by a gastroenterologist or another subspecialty. Patients receiving omeprazole for gastroprotection (e.g., with steroid or NSAID therapy) were analysed separately. Those prescribed omeprazole for reflux symptoms were divided into two groups: Group A (infants) and Group B (children). One patient was excluded due to death.Only 12.2% of prescriptions of patients included (n=6) were made by paediatric gastroenterologists, while 87.8% originated from other subspecialties. Among all prescriptions, 54% (n=27) were for reflux-related symptoms and 46% (n=22) for gastroprotective purposes. Of those prescribed omeprazole for reflux, 48% were in Group A and 52% in Group B. Complex comorbidities (genetic, metabolic, or cardiac) were present in 53.8% of Group A and 71.4% of Group B.Dietary or lifestyle modification prior to omeprazole use was attempted in 76.9% of Group A and 57.1% of Group B. Only 7.6% of Group A and 35% of Group B were referred to a gastroenterologist for further assessment (table 1). Of the 27 patients prescribed omeprazole for reflux, 44.4% (n=12) had objectively confirmed reflux through OGD, pH impedance, or laryngoscopic evaluation, while 55.6% were treated empirically based on symptoms. Among those with confirmed reflux, 80% had attempted dietary modification before starting omeprazole. Two-thirds (66.7%) of all reflux patients received omeprazole for longer than 8 weeks with no clear discontinuation plan.Our findings highlight partial compliance with NASPGHAN guidelines for paediatric reflux management, particularly treatment duration. Referral rates for persistent or complex reflux were low, indicating gaps in practice. Educational initiatives and structured outpatient resources (e.g., guideline-based brochures and checklists) are recommended to promote appropriate omeprazole use and reinforce non-pharmacological strategies. We suggest implementing these educational resources and reaudit after 6 months. Further research is warranted to evaluate omeprazole prescribing for gastroprotection and develop updated UK-specific guidance consolidating paediatric omeprazole indications, including GERD, eosinophilic esophagitis, H. pylori infection, and gastric ulcer prevention.References Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of NASPGHAN and ESPGHAN. J Pediatr Gastroenterol Nutr. 2018;66(3):516–554.Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint recommendations of NASPGHAN and ESPGHAN. J Pediatr Gastroenterol Nutr. 2009;49(4):498–547.Abstract OC90 Table 1Summary of compliance with NASPGHAN 2018 guidelinesParameterGroup A (infants)Group B (children)Attempted dietary modification before PPI76.9% (n=10/13)57.1% (n=8/14)Referral to gastroenterology7.6% (n=1/13)35.0% (n=5/14)Objective confirmation of reflux44.4% (n=12/27)*PPI duration ≤8 weeks33.3% (n=9/27)** Data not broken down by age group.",
  "authors": [
    {
      "affiliations": [
        "Great Ormond Street Hospital"
      ],
      "name": "Basma Haroun"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital"
      ],
      "name": "Wimalika Don Philip Muhandirumge"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital"
      ],
      "name": "Lisa Antona-McGovern"
    },
    {
      "affiliations": [
        "Great Ormond Street Hospital"
      ],
      "name": "Keith Lindley"
    }
  ],
  "title": "OC90 Assessment of compliance with NASPGHAN guidelines for omeprazole use in children with reflux disease",
  "uid": "d64bc376-7bf4-50c5-a089-9acc3dac9b31"
}