title: Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review.
abstract: BACKGROUND
  Use of proton-pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease (GERD) in children has increased enormously. However, effectiveness and safety of PPIs for pediatric GERD are under debate.
  
  
  OBJECTIVE
  We performed a systematic review to determine effectiveness and safety of PPIs in children with GERD.
  
  
  METHODS
  We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for randomized controlled trials and crossover studies investigating efficacy and safety of PPIs in children aged 0 to 18 years with GERD for reduction in GERD symptoms, gastric pH, histologic aberrations, and reported adverse events.
  
  
  RESULTS
  Twelve studies were included with data from children aged 0-17 years. For infants, PPIs were more effective in 1 study (compared with hydrolyzed formula), not effective in 2 studies, and equally effective in 2 studies (compared with placebo) for the reduction of GERD symptoms. For children and adolescents, PPIs were equally effective (compared with alginates, ranitidine, or a different PPI dosage). For gastric acidity, in infants and children PPIs were more effective (compared with placebo, alginates, or ranitidine) in 4 studies. For reducing histologic aberrations, PPIs showed no difference (compared with ranitidine or alginates) in 3 studies. Six studies reported no differences in treatment-related adverse events (compared with placebo or a different PPI dosage).
  
  
  CONCLUSIONS
  PPIs are not effective in reducing GERD symptoms in infants. Placebo-controlled trials in older children are lacking. Although PPIs seem to be well tolerated during short-term use, evidence supporting the safety of PPIs is lacking.
authors.affiliation: Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, C2-312, 1105 AZ Amsterdam, Netherlands. r.j.vanderpol@amc.nl
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: van der Pol
authors.forename: Marije J
authors.initials: MJ
authors.lastname: Smits
authors.forename: Michiel P
authors.initials: MP
authors.lastname: van Wijk
authors.forename: Taher I
authors.initials: TI
authors.lastname: Omari
authors.forename: Merit M
authors.initials: MM
authors.lastname: Tabbers
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage / Q000009:adverse effects; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D064747:Lansoprazole; D008297:Male; D009426:Netherlands; D009853:Omeprazole / Q000008:administration & dosage / Q000009:adverse effects; D000077402:Pantoprazole; D011379:Prognosis; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D000077402:Pantoprazole; D009853:Omeprazole