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Omeprozole therapy in pediatric patients after liver and intestinal transplantation
Stuart S Kaufman1, Elizabeth Ruby Lyden, Cindy R Brown
1Joint Section of Pediatric Gastroenterology and Nutrition, Departments of Pediatrics, University of Nebraska Medical Center and Creighton University, Omaha, Nebraska, USA.
Insights
Proton pump inhibitors like omeprazole effectively prevent gastric bleeding in pediatric transplant patients. Adjusting dosage to every 6-8 hours ensures optimal acid suppression for all patients.
Area of Science:
- Pharmacology
- Gastroenterology
- Pediatric Critical Care
Background:
- Proton pump inhibitors (PPIs) like omeprazole are increasingly used for stress-related gastric bleeding prevention in critically ill patients.
- Pediatric liver or intestinal transplant recipients are a specific at-risk group for gastric bleeding.
Purpose of the Study:
- To assess the acid-suppressive potency of omeprazole in pediatric liver or intestinal transplant patients.
- To determine optimal dosing strategies for effective acid suppression in this population.
Main Methods:
- Twenty-two pediatric patients (0.9-108 months) undergoing liver or intestinal transplantation received omeprazole (0.5 mg/kg every 12 hours) in bicarbonate suspension via nasogastric tube post-surgery.
- Gastric pH monitoring was conducted approximately two days after initiating therapy.
Main Results:
- The mean gastric pH for the entire group was 6.1 ± 0.3.
- Twelve patients (55%) showed a discontinuous omeprazole effect, with five having a mean pH < 5.
- Adjusting the dosing interval to every 6-8 hours in four of these patients significantly increased mean pH to 6.6 ± 0.2 (P < 0.01).
- No gastric bleeding attributable to erosion was observed in any patient.
Conclusions:
- Omeprazole in sodium bicarbonate suspension is effective for acid suppression in pediatric liver/intestinal transplant recipients.
- A dosage of 0.5 mg/kg every 12 hours is adequate for most, but every 6-8 hours is necessary for maximal acid suppression in all patients.
- This study supports the use of omeprazole for preventing gastric bleeding in this vulnerable pediatric population.
Background:
Proton pump inhibitors such as omeprazole are increasingly used to prevent stress-related gastric bleeding in critically ill patients. In this investigation, the acid-suppressive potency of omeprazole was assessed in one at-risk group, pediatric patients undergoing liver or intestinal transplantation, or both.
Methods:
Twenty-two patients ranging in age from 0.9 to 108 months (23.8 +/- 6.5) underwent isolated liver (n = 10) or intestinal (11 with composite liver allografts) transplantation. Omeprazole was delivered in bicarbonate suspension through a nasogastric tube. Therapy was started after surgery at 0.5 mg/kg every 12 hours. Gastric pH monitoring was performed approximately 2 days later.
Results:
For the entire group, mean gastric pH equaled 6.1 +/- 0.3, the same in recipients of isolated liver and intestinal allografts. Twelve of the 22 patients demonstrated a discontinuous omeprazole effect, that is, dissipation of acid reduction before the next dose. Five of the 12 patients with discontinuous omeprazole effect had mean gastric pH of less than 5 (3.9 +/- 0.4). In 4 of these 5, the omeprazole dosing interval was shortened to every 8 or every 6 hours, resulting in an increase in mean pH to 6.6 +/- 0.2 ( P < 0.01). In the remaining 10 of 22 patients, acid suppression was uninterrupted until the next dose. No patient experienced bleeding attributable to gastric erosion.
Conclusion:
Omeprazole suspended in sodium bicarbonate is an effective acid-suppressing agent in pediatric recipients of liver or intestinal transplant, or both. A dosage of 0.5 mg/kg every 12 hours is sufficient for most patients, but dosing every 6 to 8 hours is required to assure maximal acid suppression in all.