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Management of Drug-induced Dyspepsia in Children: Current Evidence and Clinical Approach
Uday A Pai1, Dhanasekhar Kesavelu2, Arun Wadhwa3
1Department of Pediatrics, Sai Kutir, Mumbai, Maharashtra, India.
Insights
Drug-induced dyspepsia (DID) in children is a common cause of upper GI discomfort. Management involves medication review, lifestyle changes, and preferred H2RA therapy, with PPIs for severe cases.
Area of Science:
- Pediatric Gastroenterology
- Pharmacology
- Clinical Medicine
Background:
- Drug-induced dyspepsia (DID) is an underrecognized cause of pediatric upper gastrointestinal (GI) discomfort.
- DID symptoms often mimic functional dyspepsia or gastroesophageal reflux disease (GERD).
Purpose of the Study:
- To review current evidence on diagnosing and managing pediatric DID.
- To provide an expert consensus and clinical approach for pediatric DID.
Main Methods:
- Systematic review of current evidence on pediatric DID diagnosis and management.
- Integration of expert consensus and available clinical data.
- Utilized EMPACIP Likert dyspepsia severity scale for diagnosis and monitoring.
Main Results:
- Accurate diagnosis requires thorough medication history and symptom correlation.
- Stepwise management includes drug substitution, lifestyle modifications, and pharmacotherapy.
- H2-receptor antagonists (H2RAs) are preferred for rapid relief; PPIs are for refractory cases.
Conclusions:
- An evidence-informed, algorithmic approach can standardize care for pediatric DID.
- Further research is needed on pediatric-specific diagnostic tools, epidemiology, and long-term outcomes.
- Cautious use of acid-suppressive medications is advised, with regular reassessment and tapering.
Abstract:
Drug-induced dyspepsia (DID) represents an often overlooked cause of upper gastrointestinal (GI) discomfort in children, frequently mimicking functional dyspepsia or gastroesophageal reflux disease (GERD). This review synthesizes current evidence on the diagnosis and management of pediatric DID, integrating expert consensus and available clinical data. Accurate diagnosis of pediatric DID depends on a thorough medication history, covering prescription, over-the-counter (OTC), and supplement use, alongside symptom correlation with drug exposure. Standardized tools such as the EMPACIP Likert dyspepsia severity scale may improve diagnostic precision and enable symptom monitoring. A stepwise management approach involves identifying and discontinuing or substituting the offending agent, implementing dietary and lifestyle modifications, and initiating pharmacologic therapy when needed. H2-receptor antagonists (H2RAs) are recommended as the preferred therapy due to their rapid onset, safety profile, and suitability for on-demand use, while proton pump inhibitors (PPIs) are suggested to be reserved for refractory or severe cases with mucosal injury. Prokinetic agents may have a role in select cases with motility-related symptoms, though evidence remains limited. Long-term or prophylactic use of acid-suppressive medications should be approached cautiously, with regular reassessment and tapering to prevent unnecessary exposure. Significant knowledge gaps persist regarding pediatric-specific diagnostic tools, epidemiology, and long-term outcomes. Future research should focus on validating symptom scales, clarifying drug-specific risk profiles, and developing integrated care models. An algorithmic, evidence-informed approach can help standardize care and improve outcomes for children affected by DID.
How To Cite This Article:
Pai UA, Kesavelu D, Wadhwa A, et al. Management of Drug-induced Dyspepsia in Children: Current Evidence and Clinical Approach. Euroasian J Hepato-Gastroenterol 2025;15(2):190-197.
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