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World J Gastrointest Pharmacol Ther. Nov 6, 2016; 7(4): 531-539
Published online Nov 6, 2016. doi: 10.4292/wjgpt.v7.i4.531
Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?
Mark Safe, Wei H Chan, Steven T Leach, Lee Sutton, Kei Lui, Usha Krishnan
Mark Safe, Lee Sutton, Usha Krishnan, Department of Paediatric Gastroenterology, Sydney Children’s Hospital, Randwick NSW 2031, Australia
Wei H Chan, Steven T Leach, Kei Lui, Usha Krishnan, School of Women’s and Children’s Health, University of New South Wales, Sydney NSW 2052, Australia
Lee Sutton, Department of Newborn Care, Royal Hospital for Women, Randwick NSW 2031, Australia
Author contributions: All authors contributed to the conception of the work, interpretation of data, and drafting and/or revision of final manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Usha Krishnan, Department of Paediatric Gastroenterology, Sydney Children’s Hospital, High Street, Randwick NSW 2031, Australia. usha.krishnan@sesiahs.health.nsw.gov.au
Telephone: +61-2-93821752 Fax: +61-2-93821787
Received: April 6, 2016
Peer-review started: April 7, 2016
First decision: June 6, 2016
Revised: July 16, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: November 6, 2016
Processing time: 207 Days and 16.3 Hours
Abstract

Gastroesophageal reflux is a common phenomenon in infants, but the differentiation between gastroesophageal reflux and gastroesophageal reflux disease can be difficult. Symptoms are non-specific and there is increasing evidence that the majority of symptoms may not be acid-related. Despite this, gastric acid inhibitors such as proton pump inhibitors are widely and increasingly used, often without objective evidence or investigations to guide treatment. Several studies have shown that these medications are ineffective at treating symptoms associated with reflux in the absence of endoscopically proven oesophagitis. With a lack of evidence for efficacy, attention is now being turned to the potential risks of gastric acid suppression. Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections, bacterial overgrowth, adverse bone health, food allergy and drug interactions.

Keywords: Gastroesophageal reflux; Infants; Proton pump inhibitors; Ranitidine; Safety; Adverse events

Core tip: Gastroesophageal reflux is a common phenomenon in infants, but the differentiation between gastroesophageal reflux and gastroesophageal reflux disease can be difficult. Symptoms are non-specific and there is increasing evidence that the majority of symptoms may not be acid-related. Despite this, gastric acid inhibitors such as proton pump inhibitors are widely and increasingly used, often without objective evidence or investigations to guide treatment. Several studies have shown that these medications are ineffective at treating symptoms associated with reflux in the absence of endoscopically proven oesophagitis. With a lack of evidence for efficacy, attention is now being turned to the potential risks of gastric acid suppression. Previously assumed safety of these medications is being challenged with evidence of potential side effects including GI and respiratory infections, bacterial overgrowth, adverse bone health, food allergy and drug interactions.