Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 746-752 (doi:10.1542/peds.2005-2664)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Web of Science (6)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Hibbs, A. M.
Right arrow Articles by Lorch, S. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hibbs, A. M.
Right arrow Articles by Lorch, S. A.
Related Collections
Right arrow Gastrointestinal Tract
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

REVIEW ARTICLE

Metoclopramide for the Treatment of Gastroesophageal Reflux Disease in Infants: A Systematic Review

Anna Maria Hibbs, MD and Scott A. Lorch, MD, MSCE

Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania

OBJECTIVES. Metoclopramide is a commonly used drug to treat gastroesophageal reflux disease in infants. Given its widespread use and growing concern about toxicity in this population, we conducted a systematic review of metoclopramide for the treatment of gastroesophageal reflux disease in infants.

METHODS. We performed a systematic search of PubMed and bibliographies of relevant review articles. We included cohort, case-control, and intervention studies of the efficacy, effectiveness, or toxicity of metoclopramide therapy for gastroesophageal reflux disease in infants. We excluded case reports, case series, review articles, and abstracts.

RESULTS. Twelve articles met our inclusion criteria. Of these, 11 were prospective trials, and 5 were randomized, blinded clinical trials. Study size ranged from 6 to 77 patients. Eight studies showed patient improvement with metoclopramide in at least 1 measured outcome; 1 study showed worsening symptoms with metoclopramide. Of the 5 randomized, blinded trials, 2 showed no effect of metoclopramide on any outcome, and 2 showed a significant placebo effect. Four studies commented on adverse effects of therapy, with irritability being the most frequently reported potential adverse effect of therapy. Other reported adverse effects included dystonic reactions, drowsiness, oculogyric crisis, emesis, and apnea. Among studies, there was marked heterogeneity in the patient populations, dosing, and outcomes studied. Therefore, a meta-analysis was not performed. We both agreed on a US Preventive Service Task Force rating of "poor" for the level of evidence, leading to an "inconclusive" recommendation for the safety and efficacy of metoclopramide in infants.

CONCLUSIONS. The current literature is insufficient to either support or oppose the use of metoclopramide for gastroesophageal reflux disease in infants. In the future, large blinded randomized clinical trials are needed to determine the efficacy and toxicity of metoclopramide in this population.

Key Words: systematic reviews • metoclopramide • infant • gastroesophageal reflux

Abbreviations: GER—gastroesophageal reflux • GERD—gastroesophageal reflux disease • RCT—randomized, controlled trial • USPSTF—US Preventive Services Task Force

Accepted Mar 8, 2006.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 ICAN: Infant, Child, & Adolescent NutritionHome page
R. C. Cook and T. A. Blinman
The Case of the Wretched Retcher
ICAN: Infant, Child, & Adolescent Nutrition, April 1, 2009; 1(2): 94 - 97.
[Abstract] [PDF]

Home page
 PediatricsHome page
F. Savino and E. Castagno
Overprescription of Antireflux Medications for Infants With Regurgitation
Pediatrics, May 1, 2008; 121(5): 1070 - 1070.
[Full Text] [PDF]

Home page
 PediatricsHome page
W. F. Malcolm, M. Gantz, R. J. Martin, R. F. Goldstein, R. N. Goldberg, C. M. Cotten, and for the National Institute of Child Health and Hum
Use of Medications for Gastroesophageal Reflux at Discharge Among Extremely Low Birth Weight Infants
Pediatrics, January 1, 2008; 121(1): 22 - 27.
[Abstract] [Full Text] [PDF]

Home page
 J Hum LactHome page
A. Parashar, A. Varma, and B. Sharp
Risperidone as Galactagogue?
J Hum Lact, May 1, 2007; 23(2): 143 - 143.
[PDF]

Home page
 PediatricsHome page
R. J. Martin and A. M. Hibbs
Diagnosing Gastroesophageal Reflux in Preterm Infants
Pediatrics, August 1, 2006; 118(2): 793 - 794.
[Full Text] [PDF]