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Post-publication Peer Reviews to:

ARTICLES:
Vikram Khoshoo, Dean Edell, Aaron Thompson, and Mitchell Rubin
Are We Overprescribing Antireflux Medications for Infants With Regurgitation?
Pediatrics 2007; 120: 946-949 [Abstract] [Full text] [PDF]
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P3Rs published:

[Read P3R] Gastric acid suppression as treatment for GERD is not a benign intervention
Mathew George   (2 December 2007)

Gastric acid suppression as treatment for GERD is not a benign intervention 2 December 2007
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Mathew George,
fellow
Childrens Hospital Boston

Send letter to journal:
Re: Gastric acid suppression as treatment for GERD is not a benign intervention

mathew.george{at}childrens.harvard.edu Mathew George

To the Editor:

The article written by Khoshoo et al (Pediatrics 2007;120:946-949), trying to expose the inconsistency between the perceived and confirmed diagnosis of regurgitation often leading to the unnecessary use of gastric acid (GA) suppressants, is both timely and pertinent to the practice of general pediatrics.

The benefit of GA suppressants in ameliorating the complications of regurgitation is unquestionable. However, prior to prescribing such agents, health care providers must be cognizant of their potential adverse effects. Therapy with GA suppressants increases the risk of acute gastroenteritis and community acquired pneumonia, as shown by prior studies (1). Force et al reported that the prolonged use of H2 receptor antagonists may promote vitamin B12 deficiency by impairing its GA and pepsin-mediated release from dietary sources (2, 3). More recently, researchers have recognized the nephrotoxic potential of proton pump inhibitors (PPI) through the suggested association with acute interstitial nephritis (4, 5).

Although larger cohorts of patients are needed to validate the author’s results, extrapolating them to the general pediatric population using a more conservative number will still allow for a more cost- effective use of these drugs by saving a substantial amount of health care dollars. Furthermore, avoiding their unnecessary use will prevent potentially deleterious adverse effects. It is therefore essential for health care providers to ascertain the diagnosis of regurgitation and prescribe GA suppressants more cautiously.

References:

1. Canani RB, et al. Therapy with Gastric Acidity Inhibitors Increases the risk of acute Gastroenteritis and community acquired pneumonia in children. Pediatrics 2006; 117;e817-e820.

2. Force RW, Nahata MC. Effect of histamine h2-receptor antagonists on vitamin B12 absorption. Ann Pharmacother 1992 Oct; 26(10):1283-6.

3. Ruscin JM, Page RL 2 nd, Valuck RJ. Vitamin B 12 deficiency associated with histamine (2)-receptor antagonists and a proton pump inhibitor. Ann Pharmacother 2002 May; 36(5):812-6.

4. Harmark L, et al. Proton pump inhibitor-induced acute interstitial nephritis. Br J Clin Pharmacol 2007 Jul 17 (Epub ahead of print).

5. Geevasinga N, et al. Proton pump inhibitors and acute interstitial nephritis. Clin Gastroenterol Hepatol 2006 May (4)5; 597-604.

Conflict of Interest:

None declared