Esomeprazole is one of the Proton pump inhibitors that is quite effective at reducing gastric acid production. This RCT of 51 infants (preterms to 1 month of age) randomized babies that had symptoms that were interpreted as being due to reflux. The study was really nicely done, with video monitoring, Multichannel intraluminal impedance, and cardiorespiratory monitoring.

What did they show, well the esomeprazole did what it was supposed to and reduced the number of episodes of acid reflux. There was no change in overall reflux episodes, again as you would expect. Also, as I would expect, I don’t know if you are with me in this expectation but there was absolutely no effect on any clinical outcomes: just as much bradycardia, just as much desaturation, gagging, back arching, irritability and crying or fussiness.

This confirms what previous data have already shown. That there is no reliable clinical way to diagnose reflux (apart from actual vomiting), there is no clinical score or any other way to tell which babies might have acid esophagitis other than testing for acid and looking for esophagitis.

Symptoms thought to be related to acid tend to improve with time, but they don’t improve any faster if you block acid production.