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Nocturnal acid breakthrough in children with reflux esophagitis taking proton pump inhibitors

Marian D Pfefferkorn1, Joseph M Croffie, Sandeep K Gupta

  • 1Division of Pediatric Gastroenterology/Hepatology/Nutrition, Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, 702 Barnhill Drive, Indianapolis, IN 46202, USA. mdelrosa@iupui.edu

Journal of Pediatric Gastroenterology and Nutrition
|February 4, 2006
PubMed

Insights

Nocturnal acid breakthrough is common in children on proton pump inhibitors for reflux esophagitis. Adding ranitidine did not improve healing, suggesting proton pump inhibitors alone are effective.

Area of Science:

  • Pediatric Gastroenterology
  • Pharmacology
  • Acid Reflux Management

Background:

  • Reflux esophagitis is a common condition in children.
  • Proton pump inhibitors (PPIs) are a standard treatment for pediatric reflux esophagitis.
  • Nocturnal acid breakthrough (NAB) during PPI therapy may impact treatment efficacy.

Purpose of the Study:

  • To determine the incidence of nocturnal acid breakthrough in pediatric patients receiving PPIs for reflux esophagitis.
  • To compare the healing of esophagitis in children with NAB who received PPIs with or without ranitidine.

Main Methods:

  • Prospective, double-blind study involving 18 pediatric patients (ages 1-13).
  • Esophagitis assessed via endoscopic and histologic scores.
  • Esophagogastric pH monitoring performed at week 3 to identify nocturnal acid breakthrough.
  • Patients with NAB were randomized to receive PPIs +/- ranitidine at bedtime.

Main Results:

  • Nocturnal acid breakthrough occurred in 89% of patients.
  • Esophagitis improved in all patients, with mean endoscopic and histologic scores decreasing significantly (P < 0.0020).
  • Symptoms improved significantly (P = 0.0001), but ranitidine supplementation showed no additional benefit.

Conclusions:

  • Nocturnal acid breakthrough is highly prevalent in pediatric patients on PPI therapy.
  • Despite NAB, esophagitis and symptoms improved with PPIs alone.
  • Ranitidine added at bedtime did not provide additional therapeutic benefit for healing or symptom control.
Abstract

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