Omeprazole in infants with cimetidine-resistant peptic esophagitis

doi:10.1016/S0022-3476(98)70460-3

The Journal of Pediatrics

Volume 132, Issue 2, February 1998, Pages 352-354

https://doi.org/10.1016/S0022-3476(98)70460-3 Get rights and content

Abstract

Twelve neurologically normal infants (age 2.9 ± 0.9 months) with peptic esophagitis (grade 2) who did not respond to cimetidine (in addition to positioning, cisapride, and Gaviscon) were treated with omeprazole, 0.5 mg/kg once a day, for 6 weeks. The effectiveness of omeprazole was evaluated in all infants by clinical assessment and endoscopy before and after treatment and by 24-hour gastric pH monitoring during treatment in seven infants. Omeprazole therapy led to a marked decrease in symptoms, endoscopic and histologic signs of esophagitis, and intragastric acidity. (J Pediatr 1998;132:352-4)

Section snippets

Methods

Twelve neurologically normal infants (age 2.9 ± 0.9 months) with grade 2 peptic esophagitis not responding to cimetidine were treated with omeprazole, 0.5 mg/kg (which equals 20 mg/day per 1.73 m²), once a day for 6 weeks. All patients but one had been receiving cimetidine (10 mg/kg three times a day) after endoscopy for at least 2 weeks plus cisapride (0.8 mg/kg per day in three divided doses before meals) and Gaviscon (a combination of an antacid and sodium salt of alginic acid, 1 to 2 gm/100

Results

The clinical symptoms before and during treatment with omeprazole are shown in Table I.

. Clinical symptoms in study subjects (n = 12) before and during treatment with omeprazole

Empty Cell	Before	48 hr after	6 wk
Vomiting	4	3	1
Nonregurgitant reflux	10	7	2
Crying during/after feeding	12	4	1
Irritability	10	6	0
Feeding refusal (after ± 50 ml)	8	3	0

The daily milk intake was less than the for-age recommended intake in seven of 11 infants (mean, 105 ml/kg). In one infant receiving breast milk, the intake was not measured. Weight

Discussion

Our data suggest that omeprazole, which inhibits the final step (H⁺/K⁺ ATPase) in gastric acid release from the parietal cell, is an effective therapy for histamine receptor type 2 antagonist-resistant peptic esophagitis in neurologically normal infants.

Dosages of omeprazole ranging between 20 and 40 mg/m²/day have been used in children. In this study we evaluated 0.5 mg/kg/day, which is approximately 20 mg/m²/day. This dosage clearly resulted in an effective decrease in symptoms, endoscopic

References (14)

LL. Leape
Esophageal biopsy in the diagnosis of reflux esophagitis
J Pediatr Surg
(1981)
S Kato et al.
Effect of omeprazole in the treatment of refractory acid-related diseases in childhood: endoscopic healing and twenty-four-hour intragastric acidity
J Pediatr
(1996)
P. Hyman
Gastroesophageal reflux: one reason why baby won’t eat
J Pediatr
(1994)
S Orenstein et al.
Thickened feedings as a cause of increased coughing when used as therapy for gastroesophageal reflux in infants
J Pediatr
(1992)
Y. Vandenplas
Reflux esophagitis in infants and children: a report from the working group on gastro-oesophageal reflux disease of the European Society of Paediatric Gastroenterology and Nutrition
J Pediatr Gastroenterol Nutr
(1994)
M Savary et al.
L’oesophage: manuel et atlas d’endoscopie
(1977)
T Knuff et al.
Histologic evaluation of chronic gastroesophageal reflux: an evaluation of biopsy methods and diagnostic criteria
Dig Dis Sci
(1984)

There are more references available in the full text version of this article.

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^☆: From the Department of Pediatrics, Virga Jesse Hospital, Hasselt, Belgium.

^☆☆: Reprint requests: Philippe Alliët, MD, Department of Pediatrics, Virga Jesse Hospital, Stadsomvaart 11, B-3500 Hasselt, Belgium.

^★: 9/22/82568

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Omeprazole in infants with cimetidine-resistant peptic esophagitis☆,☆☆,★

Abstract

Section snippets

Methods

Results

Discussion

J Pediatr Surg

J Pediatr

J Pediatr

J Pediatr

Reflux esophagitis in infants and children: a report from the working group on gastro-oesophageal reflux disease of the European Society of Paediatric Gastroenterology and Nutrition

J Pediatr Gastroenterol Nutr

L’oesophage: manuel et atlas d’endoscopie

Histologic evaluation of chronic gastroesophageal reflux: an evaluation of biopsy methods and diagnostic criteria

Dig Dis Sci