A multicenter, placebo-controlled, double-blind, randomized, trial was recently conducted to assess the efficacy and safety of proton-pump inhibitors (PPIs) in infants with gastro­esophageal reflux disease (J Pediatr. 2009;154:514-520) (Item 140-3). Because of the risk of more frequent lower respiratory tract infections associated with lansoprazole, the pediatric hospital in which I work has elected to use a histamine-2 blocker first. If that does not work, a pH probe is done, and the infant is kept on the PPI for a maximum of 30 days.—SHIRLEY BLEAK, DNP, FNP-C, Salt Lake City

The study Dr. Bleak refers to certainly bears careful consideration; however, as a primary-care provider in the trenches, nobody I know would ever hospitalize an infant for pH testing without trying the relatively safe and inexpensive anti-reflux medications first (their dubitable efficacy notwithstanding). As noted in my original response, reflux probably is overdiagnosed, and this is why providers should not reach for the prescription pad before trying nonpharmacologic measures.—Reuben W. Zimmerman, PA-C (142-10)