Sperm tRNA-derived fragments: molecular mechanisms and clinical implications for paternal epigenetic inheritance.

Gastroesophageal reflux (GER) is defined as the passage of gastric contents into the esophagus with or without regurgitation which is a normal physiologic process occurring several times a day in all infants., When GER leads to troublesome symptoms and/or complications, such as failure to thrive, hematemesis, esophagitis or structuring, it is defined as gastroesophageal reflux disease (GERD)., Especially in infants, it is difficult to differentiate between GER and GERD, because a golden standard is lacking and clinical manifestation of GER and GERD can be very similar. Symptoms of infant GERD may include regurgitation, excessive crying, back arching, and irritability but many of these symptoms also occur in otherwise healthy infants. In 90% of infants, these symptoms disappear by the first year of life without any intervention. However, caregivers of infants with symptoms such as regurgitation and excessive crying feel uncertain and often seek treatment, even though treatment is usually not required. It is therefore crucial to educate caregivers on the benign character of the symptoms and to explain that in most infants, the symptoms will resolve spontaneously. Acid‐suppressive medications should not be prescribed in infants with physiological GER, due to uncertain efficacy and an increased risk of pneumonia, infections, and viral gastroenteritis., , , Acid‐suppressive medications are only indicated in cases of reflux‐related erosive esophagitis, or in the absence of esophagitis when pathological acid exposure or a symptom association with acid reflux is documented using esophageal pH‐impedance monitoring., Despite the current recommendations in the GER(D) guideline, acid‐suppressive medications are still prescribed for healthy children with symptoms suggestive of GER. In addition, the abundance of online (mis)information can confuse caregivers, increasing their uncertainty about the nature of the symptoms and treatment options. Providing clear information from a reliable source could help reduce this uncertainty. Decision aids are evidence‐based tools designed to assist patients in making informed and thoughtful choices between healthcare options. Several studies in different decision contexts have shown that decision aids lead to less decisional conflict and a greater sense of being informed. Therefore, an online decision aid for caregivers of infants with symptoms suggestive of GER was developed and a prospective cohort study was performed to investigate the effect of this decision aid on reducing caregivers’ preference for acid suppressive medication and their decision certainty. The requirement for Institutional Review Board approval was waived by the Ethics Committees of Amsterdam UMC. The ethics committee of Amsterdam UMC and general hospitals approved the study. After a pilot phase, the decision aid was provided to all caregivers of infants presenting with symptoms suggestive of GER at pediatric outpatient clinics. Infants were recruited at one academic hospital (Emma Children's Hospital/Amsterdam UMC) and three general hospitals (Isala, Onze Lieve Vrouwe Gasthuis, and Spaarne Gasthuis). Infants were eligible if they were (1) <18 months old and (2) referred with symptoms suggestive of GER and if GER was part of the differential diagnosis. Exclusion criteria included (1) an indication for acid suppressive therapy according to the GER(D) guideline (e.g., hematemesis); (2) caregivers with insufficient knowledge of the Dutch language; (3) when caregivers did not have access to a computer, smartphone, or tablet with internet. For each eligible infant, one caregiver was invited to participate and, upon providing consent, received the questionnaires and decision aid. Since no studies have been published on comparable interventions within this population, a sample size calculation was not possible. Therefore, the sample size was determined based on the feasibility of participant inclusion within the recruitment period, with the target set at 100 inclusions.