Safety of medication options for treating pediatric esophagitis

Abstract

Introduction: The management of gastro-esophageal reflux and esophagitis in infants and children is challenging, and there are currently no clear practice guidelines. Given a paucity of evidence in the treatment of pediatric esophagitis, there are concerns over both the efficacy and safety of proton-pump inhibitors, histamine type 2 receptor antagonists, and prokinetics.

Areas covered: Comprehensive data from randomized-controlled trials, meta-analyses and observational studies have helped to illustrate the efficacy and safety of various pharmacologic and non-pharmacologic treatments in pediatric esophagitis. We review the evidence on the risks of antacid therapy including bone mineral density, respiratory infections and enteric infections including necrotizing enterocolitis.

Expert opinion: Evidence pertaining to the safety of proton-pump inhibitors and histamine 2 receptor antagonists in pediatric populations is lacking. Largely based on small observational and randomized controlled trials, it does appear both antacids pose an increased risk of respiratory and enteric infections, which can occur even with a short course of treatment. The benefits of treatment, especially in pediatric esophagitis, must be weighed against the potential risks. More large-scale studies are needed to better quantify short-term and long-term risks of treatment. Anti-secretory medications, mostly proton pump inhibitors, have substantially improved the management of pediatric esophagitis. Nevertheless, because of possible infectious safety concerns, their use must be restricted to validated indications only.

Keywords:

• enterocolitis
• esophagitis
• infection
• proton-pump inhibitors
• reflux disease

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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