Acid Suppression Therapy and Symptom Improvement (or Lack Thereof) in Children

Abstract

* Abbreviations: GER — : gastroesophageal reflux H2RA — : histamine H2-receptor antagonist HR — : hazard ratio PPI — : proton pump inhibitor Acid suppression therapy, in the form of histamine H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), is a common treatment in pediatrics for management of gastroesophageal reflux (GER). Symptoms commonly associated with GER in younger children include frequent emesis, back arching, fussiness, and discomfort. GER symptoms are reported in 10.3% of all children, with symptoms even more commonly noted in individuals <2 years old.1 At 4 months of age, 67% of children have daily regurgitation. Parents report a perceived problem with GER in 23% of 6-month-old infants.2 This high rate of concern results in GER being a common complaint in outpatient and inpatient settings. Combined with the ready availability of acid suppression therapy, this has led to increased prescribing of both H2RAs and PPIs in both infants and older children.3,4 Acid suppression therapy has been previously viewed as benign; however, recent research has revealed that these medications may carry risk. In this issue of Pediatrics , Malchodi et al5 assessed possible long-term adverse effects from use of acid suppression therapy. … Address correspondence to Mary Boruta, MD, Department of Pediatrics, Duke University Medical Center, DUMC 102375, Durham, NC 27710. E-mail: mary.boruta{at}duke.edu