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Omeprazole: therapy of choice in intellectually disabled children
C J Böhmer1, R C Niezen-de Boer, E C Klinkenberg-Knol
1Department of Internal Medicine, Medisch Centrum Alkmaar, Bartiméus.
Insights
Omeprazole effectively treats gastroesophageal reflux disease in intellectually disabled children, healing esophagitis and relieving symptoms. Dosing can be adjusted to maintain remission, offering a safer alternative to surgery.
Area of Science:
- Pediatric Gastroenterology
- Intellectual Disability Research
- Pharmacotherapy
Background:
- Gastroesophageal reflux disease (GERD) is prevalent in intellectually disabled children, often presenting with complex symptoms.
- Esophagitis, a common complication of GERD, requires effective management in this vulnerable population.
- Current treatment options for GERD in intellectually disabled children need thorough evaluation.
Purpose of the Study:
- To assess the efficacy and safety of omeprazole sodium in treating gastroesophageal reflux disease (GERD) and esophagitis in intellectually disabled children.
- To evaluate the impact of omeprazole on symptom relief and endoscopic healing of esophagitis.
- To determine optimal dosing strategies for healing and maintenance therapy in this population.
Main Methods:
- A cohort of 52 institutionalized intellectually disabled children with endoscopically confirmed esophagitis (grades I-IV) participated.
- Treatment involved omeprazole sodium (40 mg/d healing, 20 mg/d maintenance), with weight-based adjustments for children under 20 kg.
- Treatment effectiveness was evaluated at 3 and 6 months using symptom scoring and endoscopy, with dose adjustments for relapses.
Main Results:
- Omeprazole demonstrated high efficacy, with 86% of patients showing esophagitis healing and remission.
- Treatment was effective across all esophagitis grades (I-IV).
- Symptomatic relapses occurred in 14% upon dose reduction but resolved with dose increase; significant improvements were noted in vomiting, regurgitation, food refusal, anemia, and depression.
Conclusions:
- Omeprazole is a highly effective and safe treatment for all grades of esophagitis in intellectually disabled children.
- Therapeutic doses can be titrated based on reflux symptoms to maintain remission.
- Medical management with omeprazole offers a favorable risk-benefit profile compared to surgery, which carries high mortality and complication rates in this population.
Objective:
To study extensively the therapeutic approach of gastroesophageal reflux disease in intellectually disabled children.
Design:
We studied the effect of omeprazole sodium on healing and symptom relief in 52 institutionalized intellectually disabled children (male-female, 21:31; mean age, 15.4 years; range, 4-19 years).
Intervention:
Endoscopically proven esophagitis (grades I-IV, Savary-Miller classification) was treated with omeprazole sodium, 40 mg/d (20 mg/d for children weighing <20 kg) as healing dose for 3 months, and 20 mg/d (10 mg/d for children weighing <20 kg) as maintenance dose for another 3 months. After 3 and 6 months, results of treatment were evaluated using symptom scoring and/or endoscopy. For patients with relapse, the dose was increased.
Results:
At first endoscopy, 19 patients (36%) of 52 showed grade I esophagitis; 20 (38%), grade II; 6 (12%), grade III; and 7 (13%), grade IV. In 44 (86%) of 51 patients, treatment was effective in healing esophagitis and keeping patients in remission, independent of the severity of esophagitis. In 7 patients (14%), a symptomatic relapse was observed after decreasing the dose. However, these patients became symptom free again after increasing the dose and showed healing on endoscopy at the end of the study. One child did not finish the study for reasons not related to therapy. Marked improvement of persistent vomiting, regurgitation, food refusal, iron deficiency anemia, and signs of depression was seen at the end.
Conclusions:
Omeprazole is highly effective for all grades of esophagitis in intellectually disabled children, without adverse effects. The dose needed to maintain the remission can be titrated according to the reflux symptoms. One disadvantage of medical therapy is that it is open ended, in contrast to operation, but surgery in this population has high mortality and complication rates.