Role of Drug Therapy in the Treatment of Gastro-Oesophageal Reflux Disorder in Children

Abstract

Gastro-oesophageal reflux (GOR) is the effortless passage of gastric contents into the distal oesophagus. It can be classified as functional (or symptomatic), in which the infant remains free from disease, or a pathological (GOR disease, GORD), in which gastrointestinal, respiratory or neurobehavioural signs occur with intraoesophageal acidification and the development of oesophagitis. Functional or symptomatic GOR is successfully treated by conservative measures and does not require investigative diagnostic tools; however, both drug administration and an investigative approach are mandatory in patients with GORD. There is currently a great range of proven therapeutic options for GORD that are directed at counteracting the pathogenetic components of the disorder. In this report we discuss the role of different drug classes for treating GORD in children. The choice of therapy for GORD depends upon the severity of signs and the degree of oesophagitis. The presence of oesophagitis, as documented by endoscopy, suggests the use of antisecretory drugs; H2 receptor antagonists are the first-line agents. Nevertheless, individuals with refractory disease or those patients requiring potent inhibition of acid secretion (for example, GORD with respiratory involvement) can be given proton pump inhibitors. Other groups of patients who need potent inhibition of acid secretion are children with neurological dysfunction and those with Barrett's oesophagus. It is still unclear whether patients with frequent relapses are candidates for long term administration of antisecretory drugs or for surgical fundoplication.

Adverse effects reported in the use of gastroesophageal reflux disease treatments in children: a 10 years literature review

“…Cimetidine is rarely used clinically as there are concerns about its effect on cytochrome P450 and consequent multiple drug interactions, as well as interference with vitamin D metabolism and endocrine function . We could not find any prospective studies of paediatric patients with GERD exposed to cimetidine reporting AEs.…”

Histamine H2 receptor antagonists and proton pump inhibitors: best options for gastro-oesophageal reflux in children

“…Rarely used clinically in children due to concerns about drug interactions, and interference with vitamin D metabolism and endocrine function [8] Grade B c Effective in children with GORD, but adverse events preclude its use Famotidine Demonstrated potential benefits in a small study in children with GOR but was associated with significant adverse events [9] No specific recommendation given by Tighe et al [1] Studies in children are limited; further study is needed…”

Lansoprazole in Adolescents with Gastroesophageal Reflux Disease: Pharmacokinetics, Pharmacodynamics, Symptom Relief Efficacy, and Tolerability

“…Treatment alternatives for children with GERD include prokinetic agents, acid suppressant therapies, and anti-reflux surgery. Among these, the prokinetics (metoclopramide, domperidone, and bethanechol) are prescribed less frequently because of their potential side effects and the availability of effective acid-suppressant alternatives (25)(26)(27)(28). Surgery is usually reserved for patients with extremely severe GERD and/or GERD that is refractory to pharmacologic intervention.…”