Maintenance treatment with proton pump inhibitors for reflux esophagitis in pediatric patients: a systematic literature analysis.
OBJECTIVE
Short-term treatment with a proton pump inhibitor (PPI) is effective for healing reflux esophagitis and improving reflux symptoms in pediatric patients. Our aim was to assess the efficacy and tolerability of maintenance PPI treatment after healing of reflux esophagitis in pediatric patients.


METHODS
Systematic searches of MEDLINE, Excerpta Medica database, and recent conference abstracts.


RESULTS
Five studies evaluated the efficacy of PPI maintenance therapy (6- to 90-month follow-up) in pediatric patients after healing of reflux esophagitis. Three found no relapse of reflux esophagitis or reflux symptoms during PPI maintenance therapy; however, a low relapse rate (1/14) was also found in the placebo group of the only prospective controlled study. Two of the 5 studies (both prospective) reported relapse of reflux esophagitis at half the original healing dose of omeprazole (7 of 51 patients relapsed after 3 months; 8 of 32 within 21 months), which resolved again in most patients when the healing dose or higher was given. Four studies evaluated relapse of reflux esophagitis and/or reflux symptoms after stopping PPI therapy. Reflux symptoms recurred in 18% to 76% of patients across all 4 studies. In the 4 studies that assessed the safety of PPI maintenance therapy, adverse events were infrequent and of low severity.


CONCLUSIONS
Pediatric patients with gastroesophageal reflux disease and certain chronic comorbidities appear to have the greatest need of maintenance PPI treatment after healing of reflux esophagitis. In patients requiring maintenance therapy, PPIs appear to be well tolerated and effective in maintaining remission of reflux esophagitis and reflux symptoms.
Illueca
Marta
M
AstraZeneca LP, Wilmington, Delaware 19850-5437, USA. marta.illueca@astrazeneca.com
Wernersson
Börje
B
Henderson
Catherine
C
Lundborg
Per
P
D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D002648:Child; D004941:Esophagitis / Q000188:drug therapy* / Q000209:etiology; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D009853:Omeprazole / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D055502:Secondary Prevention
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D009853:Omeprazole