Metoclopramide for the Treatment of Gastroesophageal Reflux Disease in Infants: A Systematic Review

  title={Metoclopramide for the Treatment of Gastroesophageal Reflux Disease in Infants: A Systematic Review},
  author={Anna Maria Hibbs and Scott A. Lorch},
  pages={746 - 752}
OBJECTIVES. Metoclopramide is a commonly used drug to treat gastroesophageal reflux disease in infants. Given its widespread use and growing concern about toxicity in this population, we conducted a systematic review of metoclopramide for the treatment of gastroesophageal reflux disease in infants. METHODS. We performed a systematic search of PubMed and bibliographies of relevant review articles. We included cohort, case-control, and intervention studies of the efficacy, effectiveness, or… 
Randomized Clinical Trial of Metoclopramide as Prophylaxis of Gastroesophageal Reflux Disease in Preterm Infants
Results show absence of effectiveness in the systematic use of metoclopramide as prophylaxis of GERD symptoms in premature infants, and no adverse effects attributable to the drug were found.
Adverse effects reported in the use of gastroesophageal reflux disease treatments in children: a 10 years literature review
Adverse effects have been reported in at least 23% of patients treated with histamine H2 receptor antagonists (H2RAs) and 34% of those treated with proton pump inhibitors (PPIs) and mostly include headaches, diarrhoea, nausea, and constipation, which may place immune‐deficient infants and children, or those with indwelling catheters, at risk for the development of lower respiratory tract infections and nosocomial sepsis.
Safety of medication options for treating pediatric esophagitis
Anti-secretory medications, mostly proton pump inhibitors, have substantially improved the management of pediatric esophagitis, Nevertheless, because of possible infectious safety concerns, their use must be restricted to validated indications only.
The Safety and Efficacy of Lansoprazole plus Metoclopramide among Neonates with Gastroesophageal Reflux Disease Resistant to Conservative Therapy and Monotherapy: A Clinical Trial
The combination of each acid suppressant with metoclopramide led to a higher response rate in comparison with monotherapy used before intervention, but it was significantly higher in the “lansoprazole plus metoclOPramide” group compared with the ‘ranitidine plus metClinical GERD’ group.
Combined therapy in gastro-esophageal reflux disease of term neonates resistant to conservative therapy and monotherapy: a clinical trial
Combination of each acid suppressant with metoclopramide led to higher response rate in comparison with monotherapy used before intervention, but it was significantly higher in group A (> 90%).
An update on the latest chemical therapies for reflux esophagitis in children
Clinicians should reserve ASM use for infants and children with proven esophagitis and avoid their routine use in patients with merely symptoms of GER, and consider the controversies surrounding the use of PPIs in the pediatric population.
Gastroesophageal Reflux Disease In Neonates And Infants: A Systematic Review To Identify Best Practice For Treatment
The results of this study show that conservative therapies should be used initially in the treatment of GERD and if conservative therapies are unsuccessful, interventions including feedings can be used prior to the addition of pharmaceutical therapies.
GORD in children.
A systematic review of the effects of treatment for symptomatic gastro-oesophageal reflux on the effectiveness and safety of the following interventions: domperidone, feed thickeners in infants, H(2) antagonists, head elevatedSleep positioning, left lateral or prone sleep positioning, metoclopramide, proton pump inhibitors, sodium alginate, surgery, soy formula with added fibre, and weight loss.
Pharmacological Therapy of Gastroesophageal Reflux in Preterm Infants
This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs.
Therapies for Gastroesophageal Reflux in Infants


Dose‐response study of metoclopramide in gastroesophageal reflux in infancy
Time pH < 4 expressed as the difference between day 1 and day 2, relative to day 1, decreased significantly as a function of C1h and no side effects were observed.
Metoclopramide pharmacokinetics and pharmacodynamics in infants with gastroesophageal reflux.
The pharmacokinetics and pharmacodynamics of metoclopramide oral solution were evaluated in six infants (0.9-5.4 months) with gastroesophageal reflux (GER) following the initial and 10th dose of 0.15
Gastroesophageal reflux medications in the treatment of apnea in premature infants.
Antireflux medications do not reduce the frequency of apnea in premature infants and Stratification for documented reflux, concomitant use of methylxanthines or ranitidine, developmental age, feeding volume, and respiratory support did not identify a subgroup of patients whose apnea improved with antirefux treatment.
Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years.
Thickened feeds are helpful in reducing the symptoms of GER and metoclopramide may have some benefit in comparison to placebo in the symptomatic treatment for GER, but that must be weighed against possible side effects.
Diagnosis and management of gastro‐oesophageal reflux in preterm infants in neonatal intensive care units
Common treatment strategies for diagnosed GOR included non‐drug options—body positioning and placement on a slope and drugs—H2‐receptor antagonists (100%), feed thickeners (98%), antacids (96%), prokinetic agents (79%), proton‐pump inhibitors (65%) and dopamine‐recept antagonists (53%).
Effect of metoclopramide on prolonged intraesophageal pH testing in infants with gastroesophageal reflux.
The data suggest that if a clinical trial of MCP in infants with GER is performed, a larger dose of the medication than previously appreciated might be required.
Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group.
Complaints of regurgitation are common during the first year of life, peaking at 4 months of age, and many infants "outgrow" overt GER by 7 months and most by 1 year.