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Pediatric Surgery International

, Volume 30, Issue 4, pp 381–385 | Cite as

Proton pump inhibitors for reflux therapy in infants: effectiveness determined by impedance pH monitoring

  • Christoph CastellaniEmail author
  • Andrea Huber-Zeyringer
  • Gerhard Bachmaier
  • Amulya K. Saxena
  • Michael E. Höllwarth
Original Article

Abstract

Purpose

To evaluate the influence of proton pump inhibitors (PPI) in predominantly milk-fed infants with symptoms of GERD by 24-h pH-multichannel intraluminal impedance (24-h pH-MII).

Methods

Ten infants (8 males and 2 females) with a mean gestational age of 39 weeks (28–40) were included. 24-h pH-MII was performed before prescription and during intake of PPI. Total acid exposure time, bolus exposure time (acidic/non-acidic/total) and the number of refluxes (acidic/non-acidic/total) were determined. Clinical symptoms were recorded and used to calculate the Reflux Symptom Index (RSI) and the Symptom Severity Index (SSI).

Results

There was a significant decrease in the number of acidic refluxes, total acid exposure and acidic bolus exposure time. However, this went along with a significant increase in non-acidic bolus exposure time. The total number of refluxes and the total bolus exposure time remained unchanged. Under PPI, a decrease of SSI and RSI for pain-related symptoms could be observed. For respiratory symptoms and vomiting however no significant changes could be demonstrated.

Conclusions

Under PPI, an improvement of pain-related symptoms could be shown. The decrease of acid exposure went along with an increase of non-acidic refluxes resulting in almost constant total reflux numbers. This finding is interpreted as main reason for some persisting symptoms despite adequate PPI dosage. Concluding from our data PPI therapy should only be indicated in case of pain, but has no effect in case of vomiting or recurrent respiratory symptoms.

Keywords

Reflux GERD Infants PPI Impedance Vomiting 

Notes

Conflict of interest

None of the authors has any financial disclosure or conflict of interest.

References

  1. 1.
    Rudolph CD, Mazur LJ, Liptak GS, Baker RD, Boyle JT, Colletti RB, Gerson WT, Werlin SL (2001) Guidelines for evaluation and treatment of gastroesophageal reflux in infants and children: recommendations of the North American Society for Pediatric Gastroenterology and Nutrition. J Pediatr Gastroenterol Nutr 32(Suppl 2):S1–31PubMedCrossRefGoogle Scholar
  2. 2.
    Vandenplas Y (1993) The diagnosis and treatment of gastro-oesophageal reflux disease in infants and children. Ann Med 25(4):323–328PubMedCrossRefGoogle Scholar
  3. 3.
    Vandenplas Y, Salvatore S, Devreker T, Hauser B (2007) Gastro-oesophageal reflux disease: oesophageal impedance versus pH monitoring. Acta Paediatr 96(7):956–962PubMedCrossRefGoogle Scholar
  4. 4.
    Colletti RB, Di Lorenzo C (2003) Overview of pediatric gastroesophageal reflux disease and proton pump inhibitor therapy. J Pediatr Gastroenterol Nutr 37(Suppl 1):S7–S11PubMedCrossRefGoogle Scholar
  5. 5.
    Dodds WJ, Dent J, Hogan WJ, Helm JF, Hauser R, Patel GK, Egide MS (1982) Mechanisms of gastroesophageal reflux in patients with reflux esophagitis. N Engl J Med 307(25):1547–1552PubMedCrossRefGoogle Scholar
  6. 6.
    Hollwarth M (2012) Gastroesophageal reflux disease. In: Coran AG, Adzick NS, Krummel TM, Laberge JM, Shamberger R, Caldamone A (eds) Pediatric surgery, vol 7th., EditionSaunders, Philadelphia, pp 947–958CrossRefGoogle Scholar
  7. 7.
    Salvatore S, Arrigo S, Luini C, Vandenplas Y (2010) Esophageal impedance in children: symptom-based results. J Pediatr 157(6):949–954 (e941–942)PubMedCrossRefGoogle Scholar
  8. 8.
    Chen IL, Gao WY, Johnson AP, Niak A, Troiani J, Korvick J, Snow N, Estes K, Taylor A, Griebel D (2012) Proton pump inhibitor use in infants: FDA reviewer experience. J Pediatr Gastroenterol Nutr 54(1):8–14PubMedCrossRefGoogle Scholar
  9. 9.
    Hemmink GJ, Bredenoord AJ, Weusten BL, Monkelbaan JF, Timmer R, Smout AJ (2008) Esophageal pH-impedance monitoring in patients with therapy-resistant reflux symptoms: ‘on’ or ‘off’ proton pump inhibitor? Am J Gastroenterol 103(10):2446–2453PubMedCrossRefGoogle Scholar
  10. 10.
    van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA (2011) Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics 127(5):925–935PubMedCrossRefGoogle Scholar
  11. 11.
    Condino AA, Sondheimer J, Pan Z, Gralla J, Perry D, O’Connor JA (2006) Evaluation of gastroesophageal reflux in pediatric patients with asthma using impedance-pH monitoring. J Pediatr 149(2):216–219PubMedCrossRefGoogle Scholar
  12. 12.
    Rosen R, Lord C, Nurko S (2006) The sensitivity of multichannel intraluminal impedance and the pH probe in the evaluation of gastroesophageal reflux in children. Clin Gastroenterol Hepatol 4(2):167–172PubMedCrossRefGoogle Scholar
  13. 13.
    Rosen CA, Nurko A (2004) The importance of multichannel intraluminal impedance in the evaluation of children with persistent respiratory symptoms. Am J Gastroenterol 99:2452–2458PubMedCrossRefGoogle Scholar
  14. 14.
    Vandenplas Y, Ashkenazi A, Belli D, Boige N, Bouquet J, Cadranel S, Cezard JP, Cucchiara S, Dupont C, Geboes K et al (1993) A proposition for the diagnosis and treatment of gastro-oesophageal reflux disease in children: a report from a working group on gastro-oesophageal reflux disease. Working Group of the European Society of Paediatric Gastro-enterology and Nutrition (ESPGAN). Eur J Pediatr 152(9):704–711PubMedCrossRefGoogle Scholar
  15. 15.
    Tamhankar AP, Peters JH, Portale G, Hsieh CC, Hagen JA, Bremner CG, DeMeester TR (2004) Omeprazole does not reduce gastroesophageal reflux: new insights using multichannel intraluminal impedance technology. J Gastrointest Surg 8(7):890–897 (discussion 897–898)PubMedGoogle Scholar
  16. 16.
    Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO (2001) Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology 120(7):1599–1606PubMedCrossRefGoogle Scholar
  17. 17.
    Rudolph CD (2006) Are proton pump inhibitors indicated for the treatment of gastroesophageal reflux in infants and children? J Pediatr Gastroenterol Nutr 37:S60–S64CrossRefGoogle Scholar
  18. 18.
    Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA (2006) Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults. Cochrane Database Syst Rev 4:CD004823PubMedGoogle Scholar
  19. 19.
    Ghezzi M, Guida E, Ullmann N, Sacco O, Mattioli G, Jasonni V, Rossi GA, Silvestri M (2013) Weakly acidic gastroesophageal refluxes are frequently triggers in young children with chronic cough. Pediatr Pulmonol 48(3):295–302PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Christoph Castellani
    • 1
    Email author
  • Andrea Huber-Zeyringer
    • 1
  • Gerhard Bachmaier
    • 2
  • Amulya K. Saxena
    • 1
  • Michael E. Höllwarth
    • 1
  1. 1.Department of Pediatric and Adolescent SurgeryMedical University GrazGrazAustria
  2. 2.Department of Informatics, Statistics and DocumentationMedical University GrazGrazAustria

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