Effect of proton pump inhibition on acid, weakly acid and weakly alkaline gastro-esophageal reflux in children
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Effect of proton pump inhibition on acid, weakly acid and weakly alkaline gastro-esophageal reflux in children Helena Turk, Bruno Hauser, Jernej Brecelj, Yvan Vandenplas, Rok Orel Ljubljana, Slovenia; Brussels, Belgium Background: The effect of proton pump inhibitors on the characteristics of gastroesophageal reflux (GER) in children and adolescents was evaluated.
Original article
Methods: Twenty-one children and adolescents with symptoms suggesting GER disease (GERD) underwent upper endoscopy and a 24-hour multichannel intraluminal impedance/pH (MII-pH) monitoring before and at the end of 2 months of therapy with proton pump inhibitors (PPIs). Results: Fourteen (67%) patients reported clinically relevant symptom improvement after 2 months of PPIs intake. At the first endoscopy, 8 (38%) patients had macroscopic signs of reflux esophagitis; after two months of therapy, 6/8 (75%) patients had a complete mucosal recovery. There was a significant reduction in the total percentage of mean acid reflux time (from 13.1% to 3.8%), and the De Meester score dropped to normal (from 46.4 to 13.1). The mean number of acid refluxes decreased significantly from 48 to 15 per 24 hours, while inversely, the mean number of weakly acid refluxes increased significantly from 26 to 64 per 24 hours. PPI therapy did not affect the total number of reflux episodes, the number of liquid and mixed refluxes, the duration of esophageal bolus exposure and proximal extent of the reflux. Conclusions: In children and adolescents with GERD, PPIs do not affect the total number of reflux episodes. PPIs only decrease the acidity of refluxate. Nevertheless, the majority of patients with typical reflux symptoms may report symptom improvement. Esophagitis can be healed after PPI treatment. The treatment of weakly acid and weakly alkaline reflux remains a challenge for physicians in the future. World J Pediatr 2013;9(1):36-41
Author Affiliations: University Children's Hospital, University Medical Centre Ljubljana, Slovenia (Turk H, Brecelj J, Orel R) and UZ Brussel Kinderen, Vrije Universiteit Brussel, Brussels, Belgium (Hauser B, Vandenplas Y) Corresponding Author: Rok Orel, MD, PhD, University Children's Hospital, University Medical Centre Ljubljana, Slovenia (Tel: +386 1 522 9254; Fax: +386 1 522 9357; Email: [email protected]) doi: 10.1007/s12519-013-0405-5 ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2013. All rights reserved.
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Key words: acid reflux; gastro-esophageal reflux (disease); multichannel intraluminal impedance; pH monitoring; proton pump inhibitor
Introduction
G
astroesophageal reflux (GER) is the passage of gastric contents into the esophagus with or without regurgitation and vomiting occurring in every individual several times daily.[1] It usually consists of a brief, asymptomatic passage of gastric contents into the distal esophagus, particularly after meals. GERdisease (GERD) is a pathologic condition in which the reflux of gastric contents causes troublesome symptoms
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