Therapy With Gastric Acidity Inhibitors Increases the Risk of Acute Gastroenteritis and Community-Acquired Pneumonia in Children

Abstract

This is the first prospective study performed in pediatric patients showing that the use of GA inhibitors was associated with an increased risk of acute gastroenteritis and community-acquired pneumonia in GERD-affected children. It could be interesting to underline that we observed an increased incidence of intestinal and respiratory infection in otherwise healthy children taking GA inhibitors for GERD treatment. On the contrary, the majority of the previous data showed that the patients most at risk for pneumonia were those with significant comorbid illnesses such as diabetes or immunodeficiency, and this points to the importance of GA suppression as a major risk factor for infections. In addition, this effect seems to be sustained even after the end of therapy. The results of our study are attributable to many factors, including direct inhibitory effect of GA inhibitors on leukocyte functions and qualitative and quantitative gastrointestinal microflora modification. Additional studies are necessary to investigate the mechanisms of the increased risk of infections in children treated with GA inhibitors, and prophylactic measures could be considered in preventing them.

Gastroesophageal Reflux in Children

“…Furthermore, longterm PPIs therapy (>2.5 years) has been associated with reduced bone mineralization, induced moderate hypergastrinemia and the development of enterochromaffin-like (ECL) cell hyperplasia in up to 50% of children [69]. Lastly, acid suppression itself is a recognized risk factor for communityacquired pneumonia, gastroenteritis, candidemia and necrotizing enterocolitis in preterm infants [70][71][72][73][74][75]. In addition, antacid drugs should not be considered in the management of infant GERD, as some absorbable components may induce side effects following chronic use (milk-alkali syndrome, aluminum toxicity, renal failure and hypercalcemia) [76][77][78].…”

Prescribing Proton-Pump Inhibitors to Irritable Infants: Where is the Evidence?

“…Safety studies have shown that chronic acid suppression from PPIs may lead to increased risk of acute gastroenteritis, community-acquired pneumonia, Clostridium difficile infection and hip fracture [9][10][11]. These have been reported in older patients who may, similarly to infants, be immune compromised.…”

“…These have been reported in older patients who may, similarly to infants, be immune compromised. It is speculated that a decrease in gastric acid with PPIs may make these patients prone to infections or decreased absorption of calcium [9][10][11]. Orenstein's study showed that lansoprazole treatment in infants with GERD increased the risk of lower respiratory infections compared with placebo [3].…”

Some Data on Surgical Treatment of Gastroesophageal Reflux

“…Although, early reports were very good and enthusiastic about this new drug in its use to children should not overestimate or underestimate. This is a drug which has its own side effects as reported [6,7] which can give gastrointestinal infections, bone fractures, hypomagnesaemia or excessive, and an increase in acidity (rebound) after treatment ends. Many scholars in the years before the release date of this drug rejected surgical treatment of reflux itself, saying that treatment with this preparation would be the final solution to the problem of reflux.…”