Proton Pump Inhibitors in Pediatrics: Evaluation of Efficacy in GERD Therapy

Abstract

Gastroesophageal reflux (GER) is defined as the passage of gastric contents into the esophagus. It occurs in healthy infants and can be considered physiological process. Uncomplicated GER can present with recurrent vomiting or regurgitation without any other symptoms and is usually managed by educating, reassuring, and guiding the parent without other intervention. GER disease (GERD) refers to the appearance of troublesome symptoms or complications (erosive esophagitis, ulceration, Barrett's esophagus) and may warrant acid suppression. Proton Pump Inhibitors (PPIs) are the most effective pharmacologic agents available for the treatment of children with GERD. In the pediatric practice only omeprazole, lansoprazole and esomeprazole are available over the first year of life. The empiric use in infants with nonspecific symptoms (excessive crying, regurgitation, feeding refusal, chronic cough) is frequent without randomized controlled study. Our paper will focus on the correct indications, dosages, duration of treatment and safety of PPI use in pediatric population.

Proton Pump Inhibitors Interfere With Zinc Absorption and Zinc Body Stores

“…PPIs are now often empirically given to infants with nonspecific symptoms; such as recurrent vomiting, anorexia, irritability, excessive crying/colic and chronic cough [22, 23]. There are currently no evidence-based guidelines for the treatment of these disorders in the pediatric population, and little is known about the long-term safety and efficacy of PPI use in these patients.…”

Clinical use of gastric antisecretory drugs in pediatric patients with gastroesophageal reflux disease: a narrative review

“…Some studies suggest that the use of anti-GERD drugs may result in risks to patient safety ( 51 ), such as an increase in respiratory and gastrointestinal infections ( 3 , 28 ). In particular, in ill children with a compromised immune system, acid suppression has been associated with increased rate of nosocomial candidemia ( 52 ).…”

Failure of Proton Pump Inhibitors to Treat GERD in Neonates and Infants: A Question of Drug, Diagnosis, or Design

“…Neonatal/infantile GERD is a multidimensional disorder in that it has a “mechanical” basis that may or may not be linked to acid‐induced tissue injury. This facet of GERD is the target for the use of acid‐modifying drugs such as the proton pump inhibitors (PPIs) 1 , 2 , 3 . The antecedent to gastroesophageal reflux disease (GERD) is gastroesophageal reflux (GER), the retrograde passage of gastric contents into the esophagus.…”