Nocturnal acid breakthrough in children with reflux esophagitis taking proton pump inhibitors

被引:10
作者
Pfefferkorn, MD
Croffie, JA
Gupta, SK
Molleston, JP
Eckert, GJ
Corkins, MR
Fitzgerald, JF
机构
[1] Indiana Univ, Div Pediat Gastroenterol Hepatol Nutr, Sch Med, Indianapolis, IN 46202 USA
[2] Indiana Univ, Div Biostat, Sch Med, Indianapolis, IN 46202 USA
关键词
nocturnal acid breakthrough; reflux esophagitis; proton pump inhibitor;
D O I
10.1097/01.mpg.0000189354.48043.4e
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objectives: We aimed to determine if nocturnal acid breakthrough occurs in children receiving proton pump inhibitors for reflux esophagitis, and to compare the healing of esophagitis in children with nocturnal acid breakthrough receiving proton pump inhibitors +/- ranitidine. Methods: This is a prospective, double-blind study. Endoscopic and histologic esophagitis were scored 0-4 and 0-3, respectively. Patients were treated with a proton pump inhibitor twice daily and esophagogastric pH monitoring was performed at week 3. Patients with nocturnal acid breakthrough were randomized. One group received ranitidine and the other received placebo at bedtime in addition to proton pump inhibitor therapy. Endoscopy was performed on all patients (with pH monitoring on patients with nocturnal acid breakthrough) during the 17th week of therapy. Results: We enrolled 18 patients, ages 1 to 13 years (mean 10.3 years). Mean baseline endoscopic and histologic scores were 3.1 +/- 1.4 and 1.8 +/- 0.7, respectively. Mean dose of proton pump inhibitor was 1.3 mg/kg +/- 0.6. Nocturnal acid breakthrough was documented in 16/18 (89%) patients. Seven patients received ranitidine and 9 received placebo. The reflux index improved: mean of 14.3 at baseline, 2.0 at week 3 (P = 0.0001), and 5.1 at week 17 (P = 0.09). Nocturnal acid breakthrough persisted in 9/12 (75%) patients, 3 of whom received ranitidine at bedtime. Esophagitis improved in all patients following therapy: mean endoscopy and histology scores were 1.6 +/- 1.8 (P = 0.0020) and 0.8 +/- 0.9 (P = 0.0013), respectively. Symptoms significantly improved from a mean score of 2.0 at baseline to 0.4 at week 17 (P = 0.0001). Conclusions: Nocturnal acid breakthrough is common in pediatric patients treated with proton pump inhibitors. Reflux index remains normal in spite of nocturnal acid breakthrough. Symptoms and esophagitis continued to improve during therapy in spite of nocturnal acid breakthrough. There appears to be no additional benefit to supplementation with ranitidine at bedtime. (C) 2006 Lippincott Williams & Wilkins.
引用
收藏
页码:160 / 165
页数:6
相关论文
共 38 条
[1]   Omeprazole in infants with cimetidine-resistant peptic esophagitis [J].
Alliët, P ;
Raes, M ;
Bruneel, E ;
Gillis, P .
JOURNAL OF PEDIATRICS, 1998, 132 (02) :352-354
[2]   24 HOUR ESOPHAGEAL PH MONITORING IN GASTRO-ESOPHAGEAL REFLUX [J].
BOIXOCHOA, J ;
LAFUENTE, JM ;
GILVERNET, JM .
JOURNAL OF PEDIATRIC SURGERY, 1980, 15 (01) :74-78
[3]  
Cross LB, 2002, ANN PHARMACOTHER, V36, P912
[4]   Omeprazole for severe reflux esophagitis in children [J].
DeGiacomo, C ;
Bawa, P ;
Franceschi, M ;
Luinetti, O ;
Fiocca, R .
JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 1997, 24 (05) :528-532
[5]  
EULER AR, 1981, GASTROENTEROLOGY, V80, P957
[6]   Long-term effect of H2RA therapy on nocturnal gastric acid breakthrough [J].
Fackler, WK ;
Ours, TM ;
Vaezi, MF ;
Richter, JE .
GASTROENTEROLOGY, 2002, 122 (03) :625-632
[7]  
Festen HPM, 1999, AM J GASTROENTEROL, V94, P931
[8]  
Fouad YM, 1999, ALIMENT PHARM THERAP, V13, P1467
[9]   Effect of high-dose lansoprazole on intragastic pH in subjects who are homozygous extensive metabolizers of cytochrome P4502C19 [J].
Furuta, T ;
Shirai, N ;
Xiao, F ;
Ohashi, K ;
Ishizaki, T .
CLINICAL PHARMACOLOGY & THERAPEUTICS, 2001, 70 (05) :484-492
[10]   EFFICACY AND SAFETY OF OMEPRAZOLE FOR SEVERE GASTROESOPHAGEAL REFLUX IN CHILDREN [J].
GUNASEKARAN, TS ;
HASSALL, EG .
JOURNAL OF PEDIATRICS, 1993, 123 (01) :148-154