Treatment of oesophageal bile reflux in children: the results of a prospective study with omeprazole.
OBJECTIVE
Reflux of duodenal juice into the oesophagus has a role in the pathogenesis of both oesophageal and laryngopharyngeal inflammatory and neoplastic lesions. As little is known about effective therapy, we studied the effect of proton pump inhibitor therapy on oesophageal bile reflux in children.


METHODS
Twenty-nine children with moderate to severe erosive oesophagitis and abnormal oesophageal bile reflux were studied before and after treatment with omeprazole 1 mg/kg per day. Outcomes included a clinical symptom score, oesophageal acid and bile reflux (simultaneous 24-hour pH and Bilitec 2000 monitoring), and mucosal healing.


RESULTS
After 8 weeks of therapy, 17 (59%) of the patients were symptom-free, and 5 (17%) had minimal symptoms. Mucosal healing or reduction to low-grade oesophagitis was achieved in 25 children (86%; P < 0.0005). Mean percentages of total, upright, and supine time with oesophageal pH less than 4 were reduced from 17.0%, 16.8%, and 19.2% before treatment, to 2.83%, 3.17%, and 2.07%, respectively, after treatment (all P < 0.00001). Similarly, mean percentages of total, upright, and supine time with bile reflux were reduced from 16.96%, 12.67%, and 22.0%, to 2.27%, 1.91%, and 2.23%, respectively (P < 0.000001, P < 0.0001, and P < 0.000001, respectively).


CONCLUSIONS
Omeprazole 1 mg/kg per day is an effective therapy for the majority of children with severe erosive oesophagitis due to abnormal isolated bile reflux or combined acid and bile reflux. It remains unclear how patients with treatment-resistant bile reflux should be managed.
Orel
Rok
R
Division of Paediatrics, Department of Gastroenterology, University Medical Centre, Ljubljana, Slovenia. orel.orel@siol.net
Brecelj
Jernej
J
Homan
Matjaz
M
Heuschkel
Robert
R
D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D001655:Bile Reflux / Q000188:drug therapy* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004941:Esophagitis / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D009092:Mucous Membrane / Q000187:drug effects / Q000473:pathology; D009853:Omeprazole / Q000627:therapeutic use*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D009853:Omeprazole