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Raza D, Mohiuddin F, Khan MH, Fawad M, Raza SM. Childhood gastroesophageal reflux disease: A comprehensive review of disease, diagnosis, and therapeutic management. World J Clin Pediatr 2025; 14:101175. [DOI: 10.5409/wjcp.v14.i2.101175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 01/22/2025] [Accepted: 02/08/2025] [Indexed: 03/18/2025] Open
Abstract
Gastroesophageal reflux disease (GERD) affects both adults and children, although the symptoms differ significantly between these groups. While adults typically experience heartburn and regurgitation, children may present with more subtle signs, such as failure to thrive, chronic cough, wheezing, and Sandifer syndrome. Diagnosing GERD in children necessitates a multifaceted approach due to the diverse symptomatology and challenges in communication. Clinical assessment serves as the cornerstone of diagnosis, supported by tools like pH monitoring, esophageal impedance testing, and upper gastrointestinal endoscopy. Imaging studies, such as barium swallow, can also provide valuable insights into anatomical abnormalities and the extent of reflux. Treatment strategies for pediatric GERD include lifestyle adjustments, pharmacotherapy, and, in severe cases, surgical interventions. Lifestyle adjustments may involve changes in feeding patterns, positional therapy, and weight management. Pharmacological options range from acid suppression with proton pump inhibitors or histamine-2 receptor antagonists to surgical procedures like fundoplication for refractory cases. Personalized management is essential, considering the child’s age, symptom severity, and the presence of complications. This article aims to offer a comprehensive understanding of pediatric GERD by utilizing current research to enhance clinical approaches and improve patient outcomes.
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Affiliation(s)
- Daniyal Raza
- Department of Internal Medicine, LSU Health Shreveport, Shreveport, LA 71103, United States
| | - Farhan Mohiuddin
- Department of Internal Medicine, LSU New Orleans, New Orleans, LA 70112, United States
| | - Muhammad Haris Khan
- Department of Internal Medicine, LSU Health Shreveport, Shreveport, LA 71103, United States
| | - Maheen Fawad
- Department of Psychiatry and Behavioral Health, LSU Health Shreveport, Shreveport, LA 71103, United States
| | - Syed Musa Raza
- Department of Gastroenterology and Hepatology, Deaconess Clinic, Henderson, KY 42420, United States
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Orel R, Benninga MA, Broekaert IJ, Gottrand F, Papadopoulou A, Ribes-Koninckx C, Thomson M, Wilschanski M, Thapar N. Drugs in Focus: Proton Pump Inhibitors. J Pediatr Gastroenterol Nutr 2021; 72:645-653. [PMID: 33847286 DOI: 10.1097/mpg.0000000000003063] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Proton pump inhibitors (PPIs) are amongst the most commonly prescribed drugs in infants and children with the last decades witnessing a dramatic rise in their utilization. Although PPIs are clearly effective when used appropriately and have been regarded as safe drugs, there is growing evidence regarding their potential adverse effects. Although, largely based on adult data it is clear that many of these are also relevant to pediatrics. PPI use potentially affects gastrointestinal microbiota composition and function, decreases defence against pathogens resulting in increased risk for infections, interferes with absorption of minerals and vitamins leading to specific deficiencies and increased risk for bone fractures as well as interferes with protein digestion resulting in increased risk of sensitization to allergens and development of allergic diseases and eosinophilic esophagitis. An association with gastric, liver and pancreatic cancer has also been inferred from adult data but is tenuous and causation is not proven. Overall, evidence for these adverse events is patchy and not always compelling. Overall, the use of PPIs, for selected indications with a good evidence base, has significant potential benefit but carries more caution in infants and children. Pediatricians should be aware of the concerns regarding the potential adverse events associated with their use.
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Affiliation(s)
- Rok Orel
- Department of Gastroenterology, Hepatology and Nutrition, Faculty of Medicine, University Medical Centre Ljubljana, University Children's Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - Marc A Benninga
- Department of Pediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ilse J Broekaert
- Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Frederic Gottrand
- Pediatric Gastroenterology, Hepatology and Nutrition Department, CHU Lille, University Lille, Lille, France
| | - Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, Children's Hospital "Agia Sofia", University of Athens, Athens, Greece
| | - Carmen Ribes-Koninckx
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, La Fe University Hospital Valencia, Spain
| | - Mike Thomson
- Centre for Paediatric Gastroenterology, Sheffield Children's Hospital, Sheffield, UK
| | - Michael Wilschanski
- Gastroenterology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Nikhil Thapar
- Neurogastroenterology and Motility Unit, Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust
- UCL Great Ormond Street Institute of Child Health, London, UK
- Current address: Department of Paediatric Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
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Polonini HC, Silva SL, Loures S, Almy R, Balland A, Brandão MAF, Ferreira AO. Compatibility of proton pump inhibitors in a preservative-free suspending vehicle. Eur J Hosp Pharm 2016; 25:150-156. [PMID: 31157010 DOI: 10.1136/ejhpharm-2016-001034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 01/24/2023] Open
Abstract
Objectives To evaluate the microbiological and physicochemical compatibility of commonly used proton pump inhibitors (PPIs) esomeprazole, lansoprazole, omeprazole and pantoprazole compounded at a single concentration using SyrSpend SF Alka and stored at refrigerated temperatures (omeprazole was also stored at room temperature because it has the most widespread use). Methods Compatibility was assessed by measuring the per cent recovery at varying time points throughout a 90-day period. Quantification of the APIs was performed by a validated high performance liquid chromatography (HPLC-UV) method. This same assay was also used to determine the dosage content uniformity of the suspensions. Microbiological stability ('test in use') was assessed during 60 days and total aerobic microbial count (TAMC), total combined yeasts and moulds count (TYMC), detection of Escherichia coli and pH determination were performed. Antimicrobial effectiveness testing was determined following European Pharmacopoeia guidelines. Results Beyond-use dates of maximum 60 days for omeprazole (5 mg/mL), pantoprazole (3 mg/mL) and esomeprazole (3 mg/mL) were established. All suspensions that met the physicochemical criteria for stability also met the content uniformity criteria. The suspensions showed no antimicrobial efficiency against bacteria, yeasts and moulds as SyrSpend SF Alka is an unpreserved vehicle, but the 'test in use' showed that the suspensions can remain microbiologically stable for up to 60 days. Conclusions SyrSpend SF Alka can be used to compound palatable (taste-masking properties) preservative-free oral suspensions with almost all commonly used PPIs.
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Affiliation(s)
| | - Sharlene L Silva
- Ortofarma-Quality Control Laboratories, Matias Barbosa, MG, Brazil
| | - Shirley Loures
- Ortofarma-Quality Control Laboratories, Matias Barbosa, MG, Brazil
| | - Rachel Almy
- Eurofins-Pharma Quality Control, Sainte Croix en Plaine, France
| | - Antoine Balland
- Eurofins-Pharma Quality Control, Sainte Croix en Plaine, France
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Esposito C, Roberti A, Turrà F, Escolino M, Cerulo M, Settimi A, Farina A, Vecchio P, Di Mezza A. Management of gastroesophageal reflux disease in pediatric patients: a literature review. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2015; 6:1-8. [PMID: 29388573 PMCID: PMC5683257 DOI: 10.2147/phmt.s46250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gastroesophageal reflux (GER), defined as the passage of gastric contents into the esophagus, is a physiologic process that occurs throughout the day in healthy infants and children. Gastroesophageal reflux disease (GERD) occurs when gastric contents flow back into the esophagus and produce symptoms. The most common esophageal symptoms are vomiting and regurgitation. Lifestyle changes are the first-line therapy in both GER and GERD; medications are explicitly indicated only for patients with GERD. Surgical therapies are reserved for children with intractable symptoms or who are at risk for life-threatening complications of GERD. The laparoscopic Nissen antireflux procedure is the gold standard for the treatment of this pathology. A literature search on PubMed and Cochrane Database was conducted with regard to the management of GERD in children to provide a view of state-of-the-art treatment of GERD in pediatrics.
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Affiliation(s)
- Ciro Esposito
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Agnese Roberti
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Francesco Turrà
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Maria Escolino
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Mariapina Cerulo
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Alessandro Settimi
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Alessandra Farina
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Pietro Vecchio
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
| | - Antonio Di Mezza
- Department of Translational Medical Sciences, Pediatric Surgery, "Federico II" University of Naples, Naples, Italy
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High rate of clinical and endoscopic relapse after healing of erosive peptic esophagitis in children and adolescents. J Pediatr Gastroenterol Nutr 2014; 59:594-9. [PMID: 25023576 DOI: 10.1097/mpg.0000000000000499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of the present study was to estimate the rate of clinical and endoscopic relapse after initial treatment of erosive peptic esophagitis in children and adolescents. METHODS A total of 24 patients (2.1-16.4 years old, mean ± standard deviation [SD] 9.9 ± 3.1; male:female 3) with healed endoscopic erosive esophagitis and without gastroesophageal reflux disease (GERD)-predisposing conditions were followed up for 4 to 32.9 months (mean 20.8 ± 10.6 years). Structured clinical evaluation was performed every other week during the initial treatment and maintenance, and every 3 months after that. Whenever a clinical relapse happened, a new endoscopic evaluation was performed. Severity and frequency were scored on 10-point and 6-point semiquantitative scales, respectively. RESULTS At baseline, epigastric pain was the most reported symptom (70.8%), with intensity scored as >5 in 88.3% of patients, and median frequency of 3 (weekly; daily in 5, 20.8%). Clinical relapse was detected in 20 of 24 (83.3%) patients after a median period of 14.65 months (95% confidence interval [CI] 6.7-25.7 months). Endoscopic relapse was observed in 9 of 20 (45%) patients after a median of 25.7 months. The dose of lansoprazole needed to heal the esophagitis was not significantly associated with the risk for clinical relapse (hazard ratio [HR] 1.74, 0.94, 7.72, P = 0.06), whereas the body mass index (BMI) was directly associated with endoscopic relapse (HR 1.3, 1, 1.69, P = 0.05). CONCLUSIONS Children with healed erosive esophagitis have up to 83% clinical relapse and of the 83%, 45% had endoscopic relapse. Correlation of endoscopic relapse with clinical symptom is poor. Higher grades of esophagitis and higher BMI are risk factors for endoscopic relapse.
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Rosas-Blum E, Tatevian N, Hashmi SS, Rhoads JM, Navarro F. Non-Specific Gastric Inflammation in Children is Associated with Proton Pump Inhibitor Treatment for More than 6 Weeks. Front Pediatr 2014; 2:3. [PMID: 24479108 PMCID: PMC3895915 DOI: 10.3389/fped.2014.00003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 01/07/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND AIMS Non-specific gastric inflammation (NSGI) is a commonly reported pathological finding. We investigated if it is associated with the use of proton pump inhibitors (PPIs) in children at a single tertiary center. METHODS We performed an IRB-approved chart review of all endoscopy and biopsy reports of patients who underwent esophagogastroduodenoscopy between July 2009 and July 2010 (n = 310). Demographic data, dose, duration of exposure to PPI, and biopsy results were collected and analyzed. All esophageal, gastric, and duodenal biopsies were independently reviewed by a pathologist. Patients with acute gastritis, moderate/severe chronic gastric inflammation, or Helicobacter pylori infection were excluded. The presence of NSGI was compared between patients exposed and not exposed to PPI as well as between patients with different doses and durations of PPI exposure to assess for potential associations. RESULTS A total of 193 patients were included: 88 (46%) had a history of PPI use and 48 (25%) were found to have NSGI. Compared to patients not exposed to PPI, the odds ratio of NSGI in patients exposed to PPIs was 2.81 (95% CI: 1.36-5.93). The odds ratio of NSGI in patients exposed to PPI for >3 months was 4.53 (95% CI: 1.69-11.97). Gender, ethnicity, and age were not associated with NSGI. No histological differences were found in the esophagus and duodenum between patients exposed and not exposed to PPI. CONCLUSION This study found that PPI exposure is associated with NSGI with a higher risk for those exposed for >3 months. As the clinical implications of NSGI are not known, judicious use of PPIs is needed. Prospective studies are required to confirm and to determine the etiologic factors (i.e., alteration of the gastric pH, serum gastrin) that may be related with the presence of NGSI.
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Affiliation(s)
- Eduardo Rosas-Blum
- Division of Pediatric Gastroenterology, Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Nina Tatevian
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center, Houston, TX, USA
| | - Syed Shahrukh Hashmi
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Health Science Center, Houston, TX, USA
| | - Jon Marc Rhoads
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Health Science Center, Houston, TX, USA
- Division of Pediatric Gastroenterology, Department of Pediatrics, Children’s Memorial Hermann Hospital, Houston, TX, USA
| | - Fernando Navarro
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Texas Health Science Center, Houston, TX, USA
- Division of Pediatric Gastroenterology, Department of Pediatrics, Children’s Memorial Hermann Hospital, Houston, TX, USA
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Poddar U. Diagnosis and management of gastroesophageal reflux disease (GERD): An indian perspective. Indian Pediatr 2013; 50:119-26. [DOI: 10.1007/s13312-013-0036-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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