Pantoprazole in Pediatric Gastroesophageal Reflux Disease

Abstract

Proton-pump inhibitors (PPIs) are widely used in the treatment of gastroesophageal reflux disease, Helicobacter pylori gastritis and peptic ulcer disease. PPIs are characterized by high efficacy, safety and lack of tachyphylaxis with very selective action on the proton pump in the parietal cell. Currently, five primary PPIs are available for use in adults. Although used for similar indications in the pediatric age group, only limited data are available in children. Limited knowledge of these medications in pediatrics suggests minimal risk of short-term complications. Data are emerging on pediatric experiences with pantoprazole. Additional pharmacokinetic and clinical data are needed with this PPI, which may prove the suitability of its use in children and be used to seek pediatric labeling. A literature review of pantoprazole use in children and adolescents is presented.

Gastroesophageal Reflux and Supraesophageal Complications: Really True or Ballyhoo?

“…Quantitative estimates of the prevalence of GERD are difficult to obtain because of the scarcity of epidemiologic studies (1,14). Abnormalities of the antireflux barrier, hiatal hernia, esophageal body emptying, and gastric factors such as acid, volume, and emptying all play a role in the pathogenesis of GERD (3). Transient lower esophageal sphincter relaxation is almost always followed by physiologic reflux episodes in healthy subjects and accounts for most episodes of reflux in patients with GERD.…”

“…Gastroesophageal reflux is a common diagnosis in infants (1). Although most children "outgrow" this functional reflux, a few have disease sequelae that may include feeding problems, failure to thrive, hematemesis, anemia, esophagitis, or recurrent aspiration with pneumonia (2,3). All of these complications are associated only with the pathophysiology in the mid to distal esophagus and are limited to these anatomic areas because of the effectiveness of the upper esophageal sphincter (UES) in preventing reflux from reaching the oropharynx and beyond.…”