Efficacy and Safety of Proton Pump Inhibitors in the Management of Pediatric Gastroesophageal Reflux Disease

Abstract

Proton pump inhibitors (PPIs) are commonly prescribed to infants and children for managing gastroesophageal reflux disease (GERD). Recently published literature illustrates conflicting evidence on the efficacy of PPIs in infants and children. Randomized controlled trials and systematic reviews have demonstrated a lack of efficacy of PPIs, specifically in young infants. Furthermore, emerging evidence also suggests that PPIs are not as benign as once thought, with newer data implicating a potential association of PPIs with an increased risk of respiratory tract infections, gastrointestinal infections, bone fractures, hypomagnesemia, and the occurrence of rebound hyperacidity after discontinuation of PPI therapy. To summarize the emerging data in children, we reviewed the literature to assess the efficacy and safety of PPIs in managing pediatric GERD. Despite conflicting evidence on the efficacy of PPIs, most studies in children demonstrated some benefit when compared with placebo. With respect to the safety of PPIs in children, only a few small studies and case reports indicated a potential association of PPIs with an increased risk of respiratory tract or gastrointestinal infections, bone fractures, and hypomagnesemia; however, many of those studies had their own limitations. From the review, it is clear that further well-designed trials and observational studies are needed to shed more light on the efficacy and safety of PPIs in the pediatric population.

Severe Delayed Gastric Emptying Induces Non-acid Reflux up to Proximal Esophagus in Neurologically Impaired Patients

“…Rebound acid hypersecretion after the discontinuation of proton pump inhibitor has been reported to be a factor affecting the pH. 32 In the present study, four patients received proton pump inhibitors before stopping the medication, while 21 did not. No significant difference was observed between these 2 groups with regard to the percentage of time for which the gastric pH was < 4 (P = 0.972).…”

Toxicity of long-term use of proton pump inhibitors in children

“…The case–control study of 68 children with CDI by Turco et al 24 also showed a significantly higher rate of PPI use in those cases with CDI. However, the fact that the group of CDI cases in that study had a higher proportion of children with inflammatory bowel disease than the control group is considered a major limitation 8. The study by Brown et al 25 did not show an increased CDI risk in children receiving PPIs, whereas a 4.5 times greater CDI risk was shown in children receiving H2RAs when compared with those not receiving acid-suppressive therapy.…”

Pharmacological treatment of children with gastro-oesophageal reflux

“…Furthermore, this Cochrane review found no trials addressing the effectiveness of pro-motility agents such as domperidone. Second, an emerging body of evidence from observational studies have reported on the potential harms of these medications (10,11). These studies have shown an increased risk of infections such as pneumonia and gastroenteritis in children on PPIs and H2Ras (10,11,12).…”