Anti-reflux drugs safe for long-term use in kids

By Will Boggs, MD

NEW YORK (Reuters Health) - Long-term use of proton pump inhibitors (PPIs)--drugs such as Prilosec (omeprazole) and Prevacid (lansoprazole) that are used to stop stomach acid from "refluxing" into the esophagus--appears to be safe and effective in children, according to a report in The Journal of Pediatrics.

"PPIs are drugs that have revolutionized the practice of pediatric gastroenterology, and they have a wide margin of safety," study co-author Dr. Eric Hassall from BC Children's Hospital/University of British Columbia, Vancouver, told Reuters Health. "However, long-term use needs to be justified by an established diagnosis, and repeated attempts at withdrawal."

Hassall and associates characterized 166 pediatric patients with reflux disease who received PPIs at their institution for up to 11 years.

Most patients used omeprazole only, but a few used lansoprazole, the report indicates, and more than 90 percent of patients in the study used the PPI for more than 30 days.

Among 136 patients taking a PPI continuously, the duration of use ranged from 273 days to 11.24 years, the researchers note. Doses ranged from 4 mg to 90 mg daily.

Only six patients eventually required antireflux surgery due to poor response to PPI therapy, the authors report, and only six signs or symptoms possibly related to PPI use were seen in four patients.

"Preliminary data in adults show some potential concerns about an increased rate of some infections, B12 deficiency, and iron and calcium malabsorption," Hassall explained.

"As yet there are no guidelines for checking these parameters in children, but it's particularly important that pediatric long-term PPI patients receive nutritional advice regarding these nutrients, and it may be advisable to check iron and B12 status once a year."