Proton Pump Inhibitors in irritable refluxing infants

Babies cry, and cause their parents much concern. Distress that might once have been attributed to ‘colic’ is these days often put down to ‘reflux’, even when there isn't much evidence of it. Medications such a proton pump inhibitors (PPIs) are increasingly used, with apparent success, but as gastro-oesophageal reflux (GOR) is self-limiting anyway, only double-blind randomised placebo-controlled trials can prove genuine effectiveness.

Authors from Belgium searched the literature and performed a systematic review, focusing specifically on ‘crying and irritability’ rather than more objective outcomes (Gieruszczak–Bialek D et al. J Pediatr 2015;166:767–70). They found only 5 studies involving infants <1 year old of sufficient quality to include, although 4 of these had some risk of bias. PPIs studied included Esomeprazole, Omeprazole, Lanzoprazole and Pantoprazole, mostly given for 4 weeks. Different but well-validated parental reports on crying and irritability were used as outcomes. None of these found any significant difference between drug and placebo groups, although as expected all groups tended to improve. Most of the studies were supported by drug manufacturers in some way, which makes the lack …