Long-Term Proton Pump Inhibitor Use in Children: A Retrospective Review of Safety

Abstract

The objective of this work was to assess the efficacy of continuous proton pump inhibitor (PPI) therapy in children and to evaluate changes in biochemical, endoscopic, and histologic parameters during such treatment. A retrospective review of children receiving PPI therapy continuously for 1 year or more with baseline and follow-up esophageal and gastric biopsies on treatment was conducted to assess type, frequency, and duration of PPI dosing, symptom relief, gastrin levels, histologic findings, and adverse events. A total of 113 children (59 male, median age 4.5 years) were identified. Of these, 31% (35/113) were neurologically impaired. The median treatment duration was 35.2 months. Elevated serum gastrin levels occurred in 73% of children with no statistically significant differences in gastrin level by PPI type, dose, and dosing frequency or treatment duration. Adverse events were reported by 12% of children: diarrhea (5%) and constipation (4%) were the most frequent. Long-term PPI therapy appears to be effective, safe and well tolerated in children despite some biochemical, endoscopic, and histologic changes.

Delayed-release oral suspension of omeprazole for the treatment of erosive esophagitis and gastroesophageal reflux disease in pediatric patients: a review

“…No statistically significant differences in gastrin level according to omeprazole dosage, dosing frequency or treatment duration has been reported. 21 And no correlation between the degree or duration of hypergastrinemia and the Omeprazole for erosive esophagitis and gastroesophageal reflux disease in children Dovepress submit your manuscript | www.dovepress.com Dovepress presence of polyps or parietal cell changes. A mild elevation in transaminase levels has been reported.…”

“…Most common reported adverse effects have been nausea, vomiting, diarrhea, epigastric pain, skin rash, and irritability 17,[20][21][22] but generally no severe enough for patient to discontinue the drug. Only one case of anaphylactic reaction due to omeprazole has been reported, in a 14-year-old boy.…”

Cobalamin status in children

“…Decreased gastric acid secretion reduces cobalamin release from dietary proteins, and longterm use may lead to cobalamin deficiency (Ruscin et al 2002). However, two studies in children observed no cobalamin deficiency among patients treated with PPI for 24-35 months (ter Heide et al 2001;Tolia and Boyer 2008) There has been an increasing use of metformin in children, mainly due to the worldwide increase of type 2 diabetes in young people (Kempf et al 2008). Metformin is also used to reduce body mass index (BMI) and insulin resistance in hyperinsulinemic obese children and adolescents (Park et al 2009).…”

<i>Helicobacter pylori</i> Therapy in Children: A Focus on Proton Pump Inhibitors

“…Elevated gastrin levels have been observed in patients receiving omeprazole, but serum gastrin normalized once the drug was discontinued [39]. In addition, benign gastric changes such as parietal cell hyperplasia and gastric polyps have been observed in children and adults receiving long-term PPI therapy [81,82]. However, no carcinoid tumor formation ever has been reported in humans [81].…”

“…Other adverse effects have been reported in elderly patients on chronic PPI therapy, such as deficiency of vitamin B 12 and increased incidence of bone fractures, but these findings have not been confirmed by recent studies [82,91]. Based on current knowledge, routine testing for vitamin B 12 deficiency is not recommended in long-term PPI users [81].…”