Proton Pump Inhibitors in Children: the Good, the Bad, and the Ugly

Pasman, Eric A.; Ong, B. C. Y. W; Witmer, Claire P.; Nylund, Cade M.

doi:10.1007/s11882-020-00926-4

Cited by 21 publications

(25 citation statements)

References 84 publications

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“…Anyway, a recent study investigating the frequency of GERD in 85 toddlers with GERD symptoms found a very low incidence of GERD (3 children had abnormal reflux index at 24-hour esophageal pH monitoring, while 7 had reflux esophagitis at upper endoscopy), thus suggesting considering to be cautious with diagnostic PPI trials ( Yang et al, 2019 ). In the pediatric age group, peptic acid disorders, such as erosive esophagitis and peptic ulcer disease, are rather uncommon conditions ( Pasman et al, 2020 ; Ward and Kearns, 2013 ). The pharmacodynamics of PPIs for treatment of peptic acid disorders for children aged 1 year or older are comparable to that in adult patients ( Ward and Kearns, 2013 ).…”

Section: Clinical Usesmentioning

confidence: 99%

“…Indeed, PPIs are often empirically prescribed for infantile reflux, functional dyspepsia, chronic cough, and asthma without documented associated gastroesophageal reflux disease (GERD). The empiric use of PPIs is being scrutinized more closely as a body of evidence accumulates about their possible dangers ( Chung and Yardley, 2013 ; Cohen et al, 2015 ; Stark and Nylund, 2016 ; De Bruyne and Ito, 2018 ; Pasman et al, 2020 ). In this study, we will provide a comprehensive overview of the mechanism of actions, use (and misuse) in infants and older children, and safety profile of PPIs.…”

Section: Introductionmentioning

confidence: 99%

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A Narrative Review on Efficacy and Safety of Proton Pump Inhibitors in Children

et al. 2022

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Proton pump inhibitors (PPIs) are among the most prescribed drugs worldwide and include omeprazole, esomeprazole, lansoprazole, pantoprazole, and rabeprazole. Their use in pediatrics is approved for children older than 1 year, for the short-term treatment of symptomatic gastroesophageal reflux disease (GERD), healing of erosive esophagitis, treatment of peptic ulcer disease, and eradication of Helicobacter pylori. PPIs are also considered the standard of care for pediatric eosinophilic esophagitis. Despite the strict range of indications, the use of this class of molecules has increased in all pediatric age ranges. The long-term gastric acid suppression in children has been linked to increased risks of gastrointestinal and lower respiratory tract infections, bone fractures, and allergy. This study aims to provide a comprehensive overview of the mechanism of actions, use (and misuse) in infants and children, and safety of PPIs.

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Section: Clinical Usesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Narrative Review on Efficacy and Safety of Proton Pump Inhibitors in Children

et al. 2022

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“…Therefore, acid suppression is not considered appropriate for most infants, where the pathophysiology pertains to an immature lower esophageal sphincter. Nonetheless, the prescriptions issued for PPIs for infants suffering from troublesome reflux have increased significantly over recent years [ 4 , 18 ], and acid-suppressant therapies have become the mainstay of reflux management, despite reports of a lack of efficacy in this age group [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

A Novel In Vitro Model for Determining the Optimum pH and Dose Volume of New Liquid Alginate for Infant Reflux Suppression

et al. 2021

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Background Gastroesophageal reflux frequently occurs in infants from birth to 2 years and is characterised by reflux and regurgitation often occurring during or immediately after feeds. These reflux events can range in both frequency and severity, and as the reflux events increase, they become increasingly distressing for both the infant and the parent. The study aimed to characterise the properties of a new infant liquid alginate product, determining the optimum gastric pH and dose volume for maximum reflux suppressant activity. Methods An in vitro infant stomach model was designed and developed that allowed products to be assessed for their reflux suppression activity. The validation of the model was completed by three independent operators comparing a milk control with infant Gaviscon to evaluate the models' robustness, reproducibility, and ease of use. The model was used to establish reflux suppression activity of a new liquid alginate infant formulation in comparison with a milk control. Suppression activity was assessed at varying doses and pH within a physiological range. Results The validation study demonstrated no significant difference in refluxate volumes for the milk control within each reflux event when comparing across the three individual operators. Similarly, no statistical differences were seen during the infant Gaviscon experiments, confirming the robustness and reproducibility of the model. Significant reflux suppression was seen across the pH range (except at pH 5.75); the pH most advantageous for reflux suppression was pH 5.25. The optimum dose volume for consistently suppressing reflux was shown to be 5 ml. An infant stomach model was designed for evaluating reflux suppression activity of a formulation of liquid alginate. The optimum gastric pH and dose volume for demonstrating significant reflux suppression and the thickening of formula milk by the infant liquid alginate formulation were established. Conclusion This study confirms the mode of action of the alginate formula, demonstrating a superior reduction in the retrograde movement of in vitro gastric contents and volume of regurgitation. The study also demonstrates that optimal performance occurs in conditions that are in line physiologically with the target patient. Both actions compliment and support the efficacy of the alginate formulation as a reflux therapy agent.

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“…Hypersensitivity reactions to PPIs are mainly IgE-mediated, but non-IgE-mediated [contact dermatitis, toxic epidermal necrolysis, leukocytoclastic vasculitis or Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)] have been described. In children, immediate hypersensitivity reactions have only been exceptionally reported (3).…”

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confidence: 99%