Aluminium absorption and antacid therapy in infancy

Woodard-Knight, L; Fudge, Andrew; Teubner, J; Simmer, Karen

doi:10.1111/j.1440-1754.1992.tb02658.x

Cited by 23 publications

(10 citation statements)

References 8 publications

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“…The prolonged use of aluminium-containing antacids may lead to increased aluminium plasma concentrations in infants. (205,206) Chronic high exposure or high-dose ingestion of calcium carbonate can cause milk-alkali syndrome; a triad of hypercalcemia, alkalosis and renal failure. Therefore, aluminium-containing antacids should not be used in children with renal impairment or in infants.…”

Section: Other Considerations For Alginatesmentioning

confidence: 99%

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

Vandenplas

Rudolph

Lorenzo

et al. 2009

J. pediatr. gastroenterol. nutr.

677

807

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is an expert in gastroesophageal reflux disease and aerodigestive disorders. Yvan Vandenplas MD, PhD: YV is an expert in gastroesophageal reflux disease. Maartje Singendonk MD: MS is an expert in esophageal physiology. Michael Cabana MD: MC is a pediatrician with expertise in consensus guideline Carlo Di Lorenzo MD: CD is an expert in pediatric motility disorders and gastroesophageal reflux disease Frederic Gottrand MD: FG is an expert in esophagitis and gastroesophageal reflux disease Sandeep Gupta MD: SG is an expert in esophageal diseases. Miranda Langendam PhD: ML is aguideline methodologist Annamaria Staiano MD: AS is an expert in pediatric motility disorders and gastroesophageal reflux disease. Nikhil Thapar MD: NT is an expert in pediatric motility disorders. Neelesh Tipnis MD: NT is an expert in pediatric motility disorders. Merit Tabbers MD, PhD: MT is an expert in gastroesophageal reflux disease.

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Section: Other Considerations For Alginatesmentioning

confidence: 99%

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

Vandenplas

Rudolph

Lorenzo

et al. 2009

J. pediatr. gastroenterol. nutr.

677

807

View full text Add to dashboard Cite

show abstract

“…Infants given aluminium-containing antacids showed significant aluminium absorption compared to controls, as shown by blood and urine aluminium levels [13]. Furthermore, a case series of three infants who were not yet on dialysis, but treated with aluminium developed osteomalacia and accumulation of aluminium in bone on bone biopsy [14].…”

Section: Discussionmentioning

confidence: 99%

Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?

et al. 2011

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BackgroundAluminium-containing phosphate binders have long been used for treatment of hyperphosphatemia in dialysis patients. Their safety became controversial in the early 1980's after reports of aluminium related neurological and bone disease began to appear. Available historical evidence however, suggests that neurological toxicity may have primarily been caused by excessive exposure to aluminium in dialysis fluid, rather than aluminium-containing oral phosphate binders. Limited evidence suggests that aluminium bone disease may also be on the decline in the era of aluminium removal from dialysis fluid, even with continued use of aluminium binders.DiscussionThe K/DOQI and KDIGO guidelines both suggest avoiding aluminium-containing binders. These guidelines will tend to promote the use of the newer, more expensive binders (lanthanum, sevelamer), which have limited evidence for benefit and, like aluminium, limited long-term safety data. Treating hyperphosphatemia in dialysis patients continues to represent a major challenge, and there is a large body of evidence linking serum phosphate concentrations with mortality. Most nephrologists agree that phosphate binders have the potential to meaningfully reduce mortality in dialysis patients. Aluminium is one of the cheapest, most effective and well tolerated of the class, however there are no prospective or randomised trials examining the efficacy and safety of aluminium as a binder. Aluminium continues to be used as a binder in Australia as well as some other countries, despite concern about the potential for toxicity. There are some data from selected case series that aluminium bone disease may be declining in the era of reduced aluminium content in dialysis fluid, due to rigorous water testing.SummaryThis paper seeks to revisit the contemporary evidence for the safety record of aluminium-containing binders in dialysis patients. It puts their use into the context of the newer, more expensive binders and increasing concerns about the risks of calcium binders, which continue to be widely used. The paper seeks to answer whether the continued use of aluminium is justifiable in the absence of prospective data establishing its safety, and we call for prospective trials to be conducted comparing the available binders both in terms of efficacy and safety.

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“…32,33 Aluminum-containing antacids can increase the serum aluminum level in infants to levels that may cause osteopenia, microcytic anemia, and neurotoxicity. [34][35][36] No published data are available to support the efficacy or safety of currently available antacids (magnesium hydroxide or calcium carbonate) for long term treatment of GERD, although intermittent or short term use for reflux symptoms appears to be safe. 4 …”

Section: Antacidsmentioning

confidence: 99%

Clinical Management of Infants and Children with Gastroesophageal Reflux Disease

Whitworth¹,

Christensen

2004

The Journal of Pediatric Pharmacology and Therapeutics

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Gastroesophageal reflux refers to the passage of gastric contents including food, acid, and digestive enzymes up into the esophagus. Reflux is most commonly recognized in infants when it is associated with regurgitation, known as “spitting up,” and it is usually a self-limited, benign process that has little or no effect on normal weight gain or development. Adults and adolescents may also have reflux, which is usually either asymptomatic or recognized as dyspepsia or “heartburn.” Gastroesophageal reflux disease (GERD) is defined as symptoms or complications that result from reflux. Most evidence suggests the mechanism of reflux is due to transient relaxations of the lower esophageal sphincter at inappropriate times. The diagnosis of suspected GERD in infants and children depends on the age and the presenting symptoms. A thorough history, physical examination, and growth charts are sufficient for the evaluation and diagnosis of GERD in most infants with recurrent vomiting or children with regurgitation and heartburn. Additional evaluation may include an upper gastrointestinal series, esophageal pH monitoring, or endoscopy. The goals of GERD management are eliminating symptoms, healing esophagitis, preventing complications, promoting normal weight gain and growth, and maintaining remission. Therapeutic options include lifestyle changes, pharmacologic therapy, and anti-reflux surgery. Currently available pharmacologic agents for the treatment of GERD include antacids, mucosal protectants, prokinetic agents, and acid suppressants.

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Aluminium absorption and antacid therapy in infancy

Cited by 23 publications

References 8 publications

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

Do aluminium-based phosphate binders continue to have a role in contemporary nephrology practice?

Clinical Management of Infants and Children with Gastroesophageal Reflux Disease

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