Friday, April 22, 2011

Heartburn: Now It's a Problem for Kids?

It's very troubling to have the expansion of heartburn medication to children and even infants.  Especially when we have no evidence that they are effective and we do have evidence that long term use of acid blockers affects bone health.  But without evidence, we're still seeing prescriptions for the medication.  Here's the expert meta-analysis from the Cochrane database.  I've highlighted the relevant sentence. 

Pediatrics. 2011 Apr 4. [Epub ahead of print]

Efficacy of Proton-Pump Inhibitors in Children With Gastroesophageal Reflux Disease: A Systematic Review.

van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA.

SourceDepartment of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, Netherlands;


Introduction: Use of proton-pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease (GERD) in children has increased enormously. However, effectiveness and safety of PPIs for pediatric GERD are under debate. Objectives: We performed a systematic review to determine effectiveness and safety of PPIs in children with GERD. Methods: We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for randomized controlled trials and crossover studies investigating efficacy and safety of PPIs in children aged 0 to 18 years with GERD for reduction in GERD symptoms, gastric pH, histologic aberrations, and reported adverse events. Results: Twelve studies were included with data from children aged 0-17 years. For infants, PPIs were more effective in 1 study (compared with hydrolyzed formula), not effective in 2 studies, and equally effective in 2 studies (compared with placebo) for the reduction of GERD symptoms. For children and adolescents, PPIs were equally effective (compared with alginates, ranitidine, or a different PPI dosage). For gastric acidity, in infants and children PPIs were more effective (compared with placebo, alginates, or ranitidine) in 4 studies. For reducing histologic aberrations, PPIs showed no difference (compared with ranitidine or alginates) in 3 studies. Six studies reported no differences in treatment-related adverse events (compared with placebo or a different PPI dosage). Conclusions: PPIs are not effective in reducing GERD symptoms in infants. Placebo-controlled trials in older children are lacking. Although PPIs seem to be well tolerated during short-term use, evidence supporting the safety of PPIs is lacking.


So let's all step away from treating colic, which is likely to be associated with overgrowth of bacteria, with acid blockers. 

I have extensive information on options for adults on my website: under What Do I Treat? and GERD

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