Antacids

Antacids are enteral agents that can be used to directly buffer gastric juice and, thereby, provide rapid symptom relief. Alginate and sucralfate are surface-protective agents that bind to gastric mucosa to decrease symptoms and promote mucosal healing. According to the 2018 NASPGHAN Guidelines, neither is recommended as long-term therapy for pediatric GERD, in particular because their safety and efficacy in children have not been adequately determined. The safety of absorbable agents that contain aluminum is of specific concern. Indeed, studies have shown that prolonged treatment with aluminum-containing antacids can increase plasma aluminum levels in infants, in turn increasing risks of osteopenia, microcytic anemia, and neurotoxicity. Sucralfate also contains aluminum and may not be safe for long-term use in children.