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A new treatment strategy for children with gastro-oesophageal reflux
The increase in use of proton pump inhibitors (PPIs) in children of all ages is of concern. PPIs have been associated with numerous side-effects, including community and hospital acquired pneumonia and osteoporosis. There are data that they are not effective for the treatment of gastro-oesophageal reflux in infants.1 Lee et al from Korea propose a different approach to management – one quite similar to how inhaled corticosteroids are used to treat patients with asthma – step-up and step-down therapy. Based upon response to 8 weeks of PPI use, patients were divided into three groups: (1) observation in patients whose symptoms had resolved; (2) continual treatment for 16 weeks in those patients with attenuated symptoms; and (3) continuous treatment in patients with persistent symptoms. This was not a randomised clinical trial and the authors provide little justification for the 8-week initial treatment period. In addition, I suspect that many patients stop taking their PPIs when they feel better. Nevertheless this ‘on-demand’ therapeutic approach to children with gastro-oesophageal reflux should reduce the number of patients who are exposed to long-term PPIs. See page 9.
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