Appendix 1. QUESTIONNAIRE FOR THE EVALUATION OF THE MANAGEMENT OF
CHILDREN WITH SYMPTOMS SUGGESTIVE OF GASTRO-ESOPHAGEAL REFLUX
(REFERRED TO THE LAST 6 MONTHS)
1) How do you generally diagnose gastroesophageal reflux disease (GERD)?
a.
b.
c.
d.
e.
Through a history of typical reflux symptoms
Through esophageal and gastric ultrasonography
Through barium contrast radiography
Through specific testing (upper GI endoscopy and/or esophageal pH-monitoring)
It depends on the age of the child
2) Which drugs are the mainstay for the treatment of GERD?
a.
b.
c.
d.
e.
Gastric acid–buffering agents
Mucosal surface barriers
Histamine-2 Receptor Antagonists (H2RAs)
Proton Pump Inhibitors (PPIs)
Prokinetics
3) You prescribe PPIs:
a.
b.
c.
d.
e.
Mainly in infants
Mainly to children older than 1 year of age
Mainly to children older than 6 years of age
Mainly to children older than 12 years of age
To children of all ages
4) In an infant younger than 1 year of age with uncomplicated recurrent regurgitation and
vomiting you prescribe PPIs:
a.
b.
c.
d.
e.
If symptoms are frequent and troublesome
If symptoms are unresponsive to acid buffering agents
Only if ultrasonographic evidence of reflux is available
Only if barium contrast radiography is suggestive of reflux
Never
5) In an infant younger than 1 year of age with unexplained crying and/or distressed behavior
you prescribe PPIs:
a.
b.
c.
d.
e.
If symptoms are frequent and troublesome
If symptoms are unresponsive to acid buffering agents
Only if ultrasonographic evidence of reflux is available
Only if barium contrast radiography is suggestive of reflux
Never
6) In a child aged 5 years with vomiting and heartburn you prescribe PPIs:
a.
b.
c.
d.
e.
If symptoms are frequent and troublesome
If symptoms are unresponsive to acid buffering agents
Only if radiographic or ultrasonographic evidence of reflux is available
Only after specific testing (upper GI endoscopy and/or pH-monitoring)
Never
7) In a child aged 12 years with heartburn and chest pain you prescribe PPIs:
a.
b.
c.
d.
e.
If symptoms are frequent and troublesome
Only if symptoms are associated with vomiting
Only if radiographic or ultrasonographic evidence of reflux is available
Only after specific testing (upper GI endoscopy)
Never
8) A 2- to 4-week PPI trial could be recommended for:
a.
b.
c.
d.
e.
Children of all ages with typical reflux symptoms
Children of all ages with typical or atypical reflux symptoms
Children older than 1 year of age with typical reflux symptoms
Older children and adolescents with chronic heartburn
Only adult patients
9) Which test do you perform in a child with respiratory symptoms suspected to be GERDrelated?
a.
b.
c.
d.
e.
Esophageal and gastric ultrasonography
Barium contrast radiography
Upper GI endoscopy
pH (+ impedenance)-monitoring
2- to 4-week PPI trial
10) When do you think it is necessary to perform an upper GI endoscopy in children?
a.
b.
c.
d.
e.
Child aged 5 years with recurrent vomiting and heartburn
Child aged 5 years with respiratory symptoms suspected to be GERD-related
Child aged 12 years with recurrent vomiting and heartburn
Children of all ages with suggestive reflux symptoms
Children of all ages with radiographic or ultrasonographic evidence of reflux
11) Which of these is the most frequent adverse event of PPI therapy in infants?
a.
b.
c.
d.
e.
Hip fractures
Hematemesis
Lower respiratory tract infections
Interstitial nephritis
Failure to thrive
12) How do you generally discontinue PPI therapy?
a.
b.
c.
d.
e.
After blood testing
After ultrasonographic testing
After radiographic testing
Abrupt discontuation
Gradual weaning
13) Can you tell us how many patients have you treated with PPIs during the last 6 months?
__________ out of __________ total patients.
14) Can you tell us how many PPIs prescriptions have you made during the last 6 months?
__________ out of __________ total prescriptions.