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Histological esophagitis: clinical and histological response to omeprazole in children
R S Strauss1, K A Calenda, Y Dayal
1Division of Pediatric Gastroenterology and Nutrition, The Floating Hospital for Children at New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts, USA.
Insights
Omeprazole effectively treats pediatric esophagitis refractory to other medications. However, symptoms recurred after treatment, and long-term acid suppression therapy was needed even after histological healing.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Pharmacology
Background:
- Esophagitis in children often presents with histological changes, not always visible during esophagoscopy.
- The efficacy of omeprazole in achieving histological healing of pediatric esophagitis remains under investigation.
Purpose of the Study:
- To evaluate the impact of omeprazole on refractory histological esophagitis in pediatric patients.
- To assess symptom resolution and histological healing rates following omeprazole treatment.
Main Methods:
- Prospective study of 18 pediatric patients with histological esophagitis and recurrent symptoms despite H2-receptor antagonists and prokinetic agents.
- Omeprazole treatment adjusted by intragastric pH monitoring, with repeat esophagoscopy after 8-12 weeks.
- Evaluation of symptom response, histological healing, and serum gastrin levels.
Main Results:
- 76% of patients became asymptomatic, and 24% improved symptomatically with omeprazole.
- Approximately 40% achieved complete histological healing of esophagitis.
- Symptom recurrence was observed in all patients after omeprazole discontinuation, regardless of healing status.
Conclusions:
- Omeprazole demonstrates efficacy in treating pediatric esophagitis resistant to H2-receptor antagonists and prokinetic agents.
- Despite histological healing, long-term acid suppressive therapy appears necessary for symptom management in these patients.
- Transient hypergastrinemia occurred in some patients, particularly younger ones, normalizing after omeprazole cessation.
Abstract:
Many children with esophagitis demonstrate histological changes without gross evidence of esophagitis by esophagoscopy. The effect of omeprazole on the histological healing of esophagitis in children is unknown. Therefore, the aim of this study was to determine the effect of omeprazole on refractory histological esophagitis in pediatric patients. Eighteen patients with histological evidence of esophagitis and recurrent symptoms despite therapy with H2-receptor antagonists and prokinetic agents were prospectively treated with omeprazole. Dosing was adjusted by monitoring intragastric pH, and esophagoscopy was repeated after 8-12 weeks of omeprazole treatment. Two patients did not complete the study due to either worsening symptoms or hypergastrinemia. Of the remaining patients, 76% were asymptomatic with omeprazole treatment and 24% reported improvement in their symptoms. Approximately 40% demonstrated complete histological healing of their esophagitis. Three patients (17%) had persistent elevations in serum gastrin levels while on omeprazole treatment, which was associated with both younger patient age and higher omeprazole dosing; however, all elevated gastrin levels returned to normal after discontinuation of the medication. All patients had recurrence of their symptoms after completing a course of omeprazole, even patients with complete histological healing. Omeprazole is efficacious in treating children with esophagitis refractory to H2-receptor antagonist and prokinetic agents. However, none of the patients were able to discontinue acid suppressive therapy even after documented healing of their esophagitis.