Efficacy of Proton-Pump Inhibitors in Children With Gastroesophageal Reflux Disease: A Systematic Review abstract

INTRODUCTION: Use of proton-pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease (GERD) in children has increased enormously. However, effectiveness and safety of PPIs for pediatric GERD are under debate. OBJECTIVES: We performed a systematic review to determine effectiveness and safety of PPIs in children with GERD. METHODS: We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for randomized controlled trials and crossover studies investigating efficacy and safety of PPIs in children aged 0 to 18 years with GERD for reduction in GERD symptoms, gastric pH, histologic aberrations, and reported adverse events. RESULTS: Twelve studies were included with data from children aged 0–17 years. For infants, PPIs were more effective in 1 study (compared with hydrolyzed formula), not effective in 2 studies, and equally effective in 2 studies (compared with placebo) for the reduction of GERD symptoms. For children and adolescents, PPIs were equally effective (compared with alginates, ranitidine, or a different PPI dosage). For gastric acidity, in infants and children PPIs were more effective (compared with placebo, alginates, or ranitidine) in 4 studies. For reducing histologic aberrations, PPIs showed no difference (compared with ranitidine or alginates) in 3 studies. Six studies reported no differences in treatment-related adverse events (compared with placebo or a different PPI dosage). CONCLUSIONS: PPIs are not effective in reducing GERD symptoms in infants. Placebo-controlled trials in older children are lacking. Although PPIs seem to be well tolerated during short-term use, evidence supporting the safety of PPIs is lacking. Pediatrics 2011;127:925–935 AUTHORS: Rachel J. van der Pol, MD,a Marije J. Smits, MSc,a Michiel P. van Wijk, MD, PhD,a Taher I. Omari, PhD,b,c Merit M. Tabbers, MD,a and Marc A. Benninga, MD, PhDa aDepartment of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital AMC, Amsterdam, Netherlands; bCenter for Pediatric and Adolescent Gastroenterology, Women’s and Children’s Hospital, Children, Youth and Women’s Health Service, North Adelaide, Australia; and cSchool of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia