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Update on medications used to treat gastrointestinal disease in children
1Division of Pediatric Gastroenterology and Nutrition, Nemours Children's Clinic, Jacksonville, Florida 32207, USA.
Insights
Pediatric gastrointestinal pharmacotherapy saw progress in 1998, with cisapride warnings highlighting the need for prescribing guidelines. New reviews and emerging treatments for various pediatric GI conditions were also noted.
Area of Science:
- Pediatric Gastroenterology
- Pharmacotherapy
- Clinical Research
Background:
- Progress in pediatric gastrointestinal pharmacotherapy in 1998 faced challenges.
- Key developments included warnings about the prokinetic agent cisapride and its potential for fatal arrhythmias.
- The specific risk to children and the need for prescribing guidelines were identified.
Purpose of the Study:
- To review advancements in pediatric gastrointestinal pharmacotherapy during 1998.
- To highlight significant findings, emerging treatments, and areas requiring further research.
- To provide an overview of the state of pediatric GI pharmacotherapy.
Main Methods:
- Literature review of pediatric-oriented publications from 1998.
- Summarization of knowledge on proton pump inhibitors, probiotics, and 5-HT3 antagonists.
- Identification of emerging treatments for specific pediatric GI conditions.
Main Results:
- Cisapride warnings underscored the need for clear pediatric prescribing guidelines.
- Comprehensive reviews covered proton pump inhibitors, probiotics, 5-HT3 antagonists, GI infections, and chronic abdominal pain.
- Emerging treatments for infectious diarrhea (zinc), achalasia/Hirschsprung's disease (botulinum toxin), weight loss (megestrol acetate), and sialorrhea (glycopyrrolate) require further confirmation.
Conclusions:
- Significant progress was made in pediatric GI pharmacotherapy despite obstacles.
- Standard of care for Helicobacter pylori eradication is triple therapy, but optimal regimens need definition.
- Further research is essential to confirm the efficacy and safety of novel therapeutic developments.
Abstract:
Progress in the pharmacotherapy of pediatric gastrointestinal diseases continued during 1998 despite ongoing obstacles encountered by clinicians and researchers. The major change involved warnings that cisapride, a widely used prokinetic agent, could cause potentially fatal arrythmias in susceptible people. The risk for children is unclear and a consensus of prescribing guidelines is needed. Excellent pediatric-oriented reviews have been published that summarize our knowledge of proton pump inhibitors, probiotics, 5-hydroxtryptamine-3 (5-HT3) antagonists, and the treatment of gastrointestinal infections and chronic abdominal pain. Triple medication therapy for the eradication of Helicobacter pylori is now the standard of care, but the optimal combination and duration of therapy needs to be determined. Also described are interesting developments requiring further confirmation: the treatments of infectious diarrhea with zinc; achalasia and Hirschsprung's disease with botulinum toxin; weight loss with megestrol acetate; and sialorrhea with glycopyrollate.