Childhood gastroesophageal reflux disease: A comprehensive review of disease, diagnosis, and therapeutic management

Table 4 Summary of pharmacologic treatments for pediatric gastroesophageal reflux disease, including their uses, advantages, side effects, and relevant references

Drug category	Examples	Uses	Advantages	Side effects	Ref.
H2RAs	Cimetidine, nizatidine	Treats erosive esophagitis, reduces acid secretion	Effective short-term relief, better than placebo	Tachyphylaxis after approximately 6 weeks, risk of liver disease, gynecomastia with cimetidine	Canani et al[36], Orenstein et al[37]
Proton pump inhibitors	Omeprazole, lansoprazole	Treats GERD, maintains gastric pH > 4, effective for esophagitis resistant to H2RAs	Long-term effectiveness, better symptom control	Headaches, diarrhea, nausea, increased risk of infections (e.g., pneumonia)	Canani et al[36], Illueca et al[38]
Prokinetic agents	Erythromycin	Improves esophageal peristalsis, accelerates gastric emptying	Helpful in cases where acid suppressants are insufficient	Potential gastrointestinal discomfort, antibiotic-related side effects	Chicella et al[40]
Gamma-aminobutyric acid(B) receptor agonists	Baclofen, AZD3355, AZD9343	Reduces TLESRs	Promising for refractory cases, fewer CNS effects with newer agents	Baclofen: CNS side effects; AZD3355 and AZD9343: Not yet validated in pediatrics	Lehmann[42], Kuo and Holloway[44]
Metabotropic glutamate receptor 5 modulators	ADX10059	Reduces acid reflux, targets TLESRs	Potential for symptom improvement in GERD	Dizziness, limited data, needs further research	Lehmann[42], Keywood et al[43]

CNS: Central nervous system; GERD: Gastroesophageal reflux disease; H2RAs: Histamine-2 receptor antagonists; TLESRs: Transient lower esophageal sphincter relaxations.