Saturday, July 01, 2006

Treating GERD with medications

Previously Appeared in Online Health Website for Children

Summer 2006

Treating GERD with medications
By Pamela Appea

Pediatric gastroenterologists may not be able to agree how many GERD cases there are in the pediatric population, but many agree that GERD is on the rise among both boys and girls from ages 0-17.

But regardless of when GERD starts or when it is diagnosed, pharmacological treatment can and should be available to even the youngest GERD patients.

GERD or gastroesophageal reflux disease in infant children may be difficult to treat for a variety of reasons. Firstly, parents of infants may assume that GERD is colic or simply resign themselves to crying, excessive vomiting and extreme discomfort before they actually seek treatment from a physician.

Secondly, once the child has visited a pediatrician, it may take some time before GERD sufferers are referred to a specialist and received a formal diagnosis. Pediatricians usually want to rule out other factors for vomiting, including allergic reactions to food and/or formula, adverse reactions to second-hand cigarette smoke.

Thirdly, some parents chose to delay seeing a specialist or getting the GERD tests done since they may cause the child discomfort, require fasting and the procedures often feature tubes that go into your nose, down your throat into your esophagus.

Once a pediatric gastroenterologist meets with the child (and his/her parents), it may take some time to find the right medication and the right dosage of medication to effectively treat the GER. Some medications work better than others; there is still more research that needs to be done on pediatric GERD medications as there have been few to no pediatric clinical trials for most FDA-approved GERD medications.

Many doctors agree that young children with gastroesophageal reflux (GER) and GERD benefit from lifestyle changes, before and/or after prescribing GERD medications. Physicians characterize children with GER as “happy spitters.” But GERD suffers frequently refuse food, fail to gain an adequate amount of weight and they are irritable or sad the majority of the time.

Some of physician-recommended lifestyle changes for babies, infants and older children include thickening formula (for infants), more frequent, smaller feedings or meals and upright positioning after feeding or eating.

But even the youngest of GERD suffers should be able to get effective pharmacological-based treatment, as there a number of medications available on the market that are suitable for pediatric populations.

A pediatric gastroenterologist will consider a number of factors when prescribing medications, including the weight of the child, the severity of the GERD and avoiding other medications that may not have appeared to be as effective in the past.

As Dr. Ben Gold, Professor of Pediatrics and Microbiology Director, Division of Pediatric Gastroenterology, Hepatology and Nutrition at Emory, explains, there are a number of different classes of medications that are available for pediatric GERD sufferers. Antacids over the counters medicine, including Maalox. Tums and Rolaids are typically used for the mildest version of esophageal discomfort.

Acid reducers, Histamine 2 receptor blockers, also known as H2 blockers and the proton pump inhibitors (PPIs) are the three main classes of medications used to treat GERD.

Ranitidine, an acid-reducer, more commonly known as Zantac is frequently prescribed for children.

The stronger PPI medications for more severe GERD cases, said Dr. Gold, are very effective.

Lansoprazole (also known as Prevacid) is suitable for ages 1-17; Omeprazole (also known as Prilosec) is suitable for children ages 2-16; and Esomeprazole (also known as Nexium) are some examples of medications suitable for older children ages 12-17, according to Dr. Gold. Some adult GERD medications, including many PPIs have not yet been approved for use in younger children. .

“When it comes to symptom resolution and disease resolution of GERD, PPIs are superior to acid blockers,” Dr. Gold said. He noted, however, that many PPIs have significant side effects. Depending on the dose and the specific medication, these side effects may include abdominal pain, headache, diarrhea, dry mouth, lightheadedness, headache and rash.

Some other studies have found that prescribing drugs like Prilosec for pediatric patients, might mean they could face risks of pancreatitis and/or liver problems.

Many doctors like Dr, Gold stress the importance of taking a conservative approach, and not prescribing stronger medications than necessary, especially if a child has a milder version of GER or GERD.

Physicians typically prescribe a medication to see if it will work, assessing the child to see if the GERD symptoms have improved or not after about two weeks.
Then the pediatric gastroenterologist will consider a stronger dosage or a different medication altogether.

The North American Society of Pediatric Gastroenterology, Hematology and Nutrition released guidelines in 2001 for appropriate medication usage among children with GERD.

In some instances, typically the most extreme cases of pediatric and adolescent GERD, a pediatric gastroenterologist may recommend corrective surgery. These typically are minimally invasive procedures.

One of the more common procedures to treat GERD or reflex is called Nissen fundoplication. This procedure wraps the top part of the stomach around the bottom part of the esophagus creating a collar. Once this procedure has been completed, the collar around the esophagus effectively prevents reflux from occurring.

But as Dr. Gold states, there is a common misperception that surgery is the last resort. He often recommends surgery for patients who have “experienced moderate success” with GERD medications, but who want surgery for a variety of different reasons. Patients, Dr. Gold, may get tired of taking multiple medications and/or continue to have mild to moderate symptoms of reflux.