Omeprazole treatment of children with peptic esophagitis refractory to ranitidine therapy.
OBJECTIVE
To evaluate the cause of chronic abdominal pain lasting more than 3 weeks in 153 patients aged 6 to 18 years (mean, 9.9 years) who had undergone endoscopy.


METHODS
Those patients with peptic esophagitis as the cause of their chronic pain were treated with high-dose ranitidine hydrochloride, followed by the proton-pump inhibitor, omeprazole, for those who did not respond to a histamine2-receptor antagonist.


RESULTS
Eighty-four percent of patients had peptic esophagitis, 3% had Helicobacater pylori gastritis, and 3% had ulcer disease. Seventy percent of the patients with peptic esophagitis responded to an 8-week course of high-dose ranitidine hydrochloride (4 mg/kg per dose, twice a day or three times a day). Of the 30% of patients who failed to respond to ranitidine therapy, 87% responded to an 8-week course of omeprazole (20 mg/d). The grade of esophagitis at initial endoscopy was a predictive factor for response to ranitidine therapy. Ninety percent of patients with grade 1 esophagitis responded to ranitidine therapy vs only 43% of those with grade 3 or 4 esophagitis. Only five patients (4%) failed to respond to both therapies; three of these subsequently underwent Nissen fundoplications. There were no side effects of either ranitidine or omeprazole therapy.


CONCLUSIONS
These findings indicate that (1) peptic esophagitis was a common cause of chronic abdominal pain in pediatric patients and (2) omeprazole was effective in the treatment of esophagitis in children and adolescents that was resistant to high-dose histamine2-receptor antagonists.
Karjoo
M
M
Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, Mo.
Kane
R
R
D015746:Abdominal Pain / Q000188:drug therapy* / Q000209:etiology; D000293:Adolescent; D002648:Child; D002908:Chronic Disease; D004351:Drug Resistance; D004942:Esophagitis, Peptic / Q000150:complications / Q000188:drug therapy*; D005756:Gastritis / Q000150:complications / Q000382:microbiology; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D009853:Omeprazole / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000150:complications; D011446:Prospective Studies; D011899:Ranitidine / Q000627:therapeutic use*
D011899:Ranitidine; D009853:Omeprazole