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Esophagitis in children: an update on current pharmacotherapy

Harohalli Shashidhar1, Vasundhara Tolia

  • 1Elliot Hospital, New Hampshire Hospital for Children, Pediatric Gastroenterology and Nutrition , Manchester, NH 03109 , USA hshashidhar@elliot-hs.org.

Expert Opinion on Pharmacotherapy
|October 22, 2013
PubMed

Insights

Proton pump inhibitors effectively treat reflux esophagitis in children but do not improve reflux symptoms in infants. Eosinophilic esophagitis and reflux esophagitis share features, with proton pump inhibitors potentially acting beyond acid suppression.

Area of Science:

  • Pediatric Gastroenterology
  • Immunology
  • Pharmacology

Background:

  • Esophagitis in children has diverse causes and complex mechanisms.
  • Understanding of esophagitis pathogenesis and treatment is continually advancing.

Purpose of the Study:

  • To review current clinical practice and research on pediatric esophagitis.
  • To discuss the use, safety, and efficacy of proton pump inhibitors (PPIs) in children.
  • To explore esophageal eosinophilia and the overlap between reflux and eosinophilic esophagitis.

Main Methods:

  • Literature search using keywords: pediatric gastroesophageal reflux disease, eosinophilia, esophageal eosinophilia, esophagitis, eosinophilic esophagitis, proton pump inhibitors.
  • Review focused on recent clinical practice and research interests.

Main Results:

  • Proton pump inhibitors (PPIs) are effective for healing reflux esophagitis in all pediatric age groups.
  • PPIs did not improve gastroesophageal reflux-related symptoms in infants.
  • Clinical and histological overlap exists between reflux and eosinophilic esophagitis.

Conclusions:

  • PPIs may have mechanisms of action beyond acid suppression in treating esophagitis.
  • Further research is needed on weakly acidic/alkaline reflux, new medications, and efficacy assessment tools for eosinophilic esophagitis.
Abstract

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