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Safety of medication options for treating pediatric esophagitis
Marc Bardou1, Kyle J Fortinsky
1Centre d'Investigations Cliniques CIC1432, CHU de Dijon , 14 rue Gaffarel BP77908, 21079, Dijon Cedex , France marc.bardou@u-bourgogne.fr.
Insights
Managing pediatric esophagitis is difficult, with concerns about acid-reducing medications. Studies suggest antacids increase infection risks, necessitating careful use in children.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
- Clinical Practice Guidelines
Background:
- Gastro-esophageal reflux and esophagitis management in children lacks clear guidelines.
- Concerns exist regarding the efficacy and safety of common treatments like proton-pump inhibitors (PPIs) and histamine type 2 receptor antagonists (H2RAs).
Purpose of the Study:
- To review evidence on the efficacy and safety of pharmacologic and non-pharmacologic treatments for pediatric esophagitis.
- To evaluate the risks associated with antacid therapy, including effects on bone mineral density and infection rates.
Main Methods:
- Systematic review of randomized-controlled trials, meta-analyses, and observational studies.
- Analysis of data on the risks of antacid therapy in pediatric populations.
Main Results:
- Limited evidence exists on the safety of PPIs and H2RAs in children.
- Antacids appear to increase the risk of respiratory and enteric infections, even with short-term use.
Conclusions:
- The benefits of treating pediatric esophagitis must be weighed against potential risks, particularly infections.
- Anti-secretory medications, primarily PPIs, have improved management but require restricted use due to safety concerns.
- Larger studies are needed to fully understand the short-term and long-term risks of these treatments.
Introduction:
The management of gastro-esophageal reflux and esophagitis in infants and children is challenging, and there are currently no clear practice guidelines. Given a paucity of evidence in the treatment of pediatric esophagitis, there are concerns over both the efficacy and safety of proton-pump inhibitors, histamine type 2 receptor antagonists, and prokinetics.
Areas Covered:
Comprehensive data from randomized-controlled trials, meta-analyses and observational studies have helped to illustrate the efficacy and safety of various pharmacologic and non-pharmacologic treatments in pediatric esophagitis. We review the evidence on the risks of antacid therapy including bone mineral density, respiratory infections and enteric infections including necrotizing enterocolitis.
Expert Opinion:
Evidence pertaining to the safety of proton-pump inhibitors and histamine 2 receptor antagonists in pediatric populations is lacking. Largely based on small observational and randomized controlled trials, it does appear both antacids pose an increased risk of respiratory and enteric infections, which can occur even with a short course of treatment. The benefits of treatment, especially in pediatric esophagitis, must be weighed against the potential risks. More large-scale studies are needed to better quantify short-term and long-term risks of treatment. Anti-secretory medications, mostly proton pump inhibitors, have substantially improved the management of pediatric esophagitis. Nevertheless, because of possible infectious safety concerns, their use must be restricted to validated indications only.
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