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An 18 month old boy with cerebral palsy is brought to your office because of "spitting up" after feeds. It has been a problem for the past several months, but is progressively worsening and now occurs after every meal and even at night. He was breast fed for 12 months and has slight developmental delay. Height and head circumference are between 25-50th centile, but weight is below 5th centile for age. A barium swallow reveals significant gastro-oesophageal reflux to the pharynx. A gastroscopic examination with biopsy reveals moderate oesophagitis without eosinophilia. You wonder if a proton pump inhibitor will be an effective treatment.
Structured clinical question
In children with gastro-oesophageal reflux [patients] does treatment with a proton pump inhibitor [intervention] decrease symptoms, increase gastric pH, and improve endoscopic findings [outcome]?
Search strategy and outcome
Pubmed: "treatment of gastroesophageal reflux in children"-limited to ages 0-18, English language, and human subjects.
1966-present: 1039 articles, seven relevant. See table 2.
Citation | Study group | Study type (level of evidence) | Outcome | Key result | Comments |
Cucchiara et al (1993) | 32 children (6 months to 13 years) with severe reflux oesophagitis and failed ranitidine and cisapride. Patients randomised to high dose ranitidine (20 mg/kg/day) or omeprazole (40 mg/day/1.73m2 ) for 8 weeks | RCT | Clinical | Both regimens effective. Decreased clinical score (p<0.01) Omep: 24 (15-33) to 9 (0-18) Ran: 19.5 (12-33) to 9 (6-12) | Double blind RCT; 7 (22%) drop out; 6 month follow up. High relapse rate after treatment; 5/13 (38%) ranitidine and 7/12 (58%) omeprazole patients... |