Pediatric Acid Reflux and Gastroesophageal Reflux (GERD)
Acid reflux and Gerd are on the rise in children. And, doctors are increasingly prescribing PPIs and other medications for treatment. Pediatric GERD patients experience poor feeding, irritability, respiratory issues, slow growth. Physicians believe the excess weight plays a role in GERD in children. Many studies have made associations between weight and GERD in adults And a few studies, such as the one conducted by Malay et al, shows that “children diagnosed with GERD or those who presented with symptoms of GERD are more likely to be obese” (2009).
An increase in GERD incidents means an increase in medication being prescribed for children to tackle the symptoms. I’ve had acid reflux all my life and I used to take prevacid. When my children were younger, they were given prevacid and ranitidine to manage acid reflux. I took them off after I started having joint pains and became malnourished from taking prevacid for years. Research presented at the 2017 Pediatric Academic Societies Meeting, found infants prescribed antacids to manage acid reflux, or spitting up, under age 1 had more bone fractures later in childhood (American Academy Of Pediatrics).
Due to unacceptable levels of NDMA (carcinogen) in ranitidine, last month, the FDA asked that all forms of the medication (prescription and OTC) be removed from the U.S. market (2020).
According to Rybak, Pesce, Thapar and Borrelli, “Infants are especially prone to regurgitate and it has been shown that the number of infants with this phenomenon decreases from about 80% during the first month of life to less than 10% at the age of one year (2017).
PPIs have been linked to kidney diseases, B12 deficiency, lupus, acute interstitial nephritis (AIN), Osteoporosis, fractures and Clostridium difficile (CDI) infections. There’s been an increase in community acquired hypervirulent strain of CDI infection in the last few years. In the US, the incidence has doubled since the 1990s, to 95.3 cases per 100 000 in acute care settings. Infection rates have risen also in children—they were previously believed to be at low (Kim and Zhu, 2017).
PPIs indirectly block histamine, increasing gastric acid pH. pH above 4 increases bacterial survival. According to Mezoff, and Cohen, an observational, case-control study performed on children admitted to the Department of Pediatrics, University of Naples, found that, of 910 children admitted for abdominal pain and diarrhea who underwent testing for CDI, 68 were found to be positive. The use of PPIs was significantly higher in those testing positive for C. difficile toxin (OR 4.52, 95% CI, 1.4–14.4) (2013).
Regurgitating is common and normal in children, so is GERD on the rise in children or doctors are simply overprescribing these medications without actually exploring the root cause of these issues. I believe the pharmaceutical industry has over-represented the overall burden of GERD in adults and pediatric populations to sell more of their products. Even in certain adults, sometimes eating more fiber solves the problem. It’s all about addressing the root cause of a patient’s problems instead on giving medication as a band aid. Be your own advocate and force doctors to find the root cause of your issues. If you current doctor won’t listen, find someone who will.
Kim, G., & Zhu, N. A. (2017). Community-acquired Clostridium difficile infection. Canadian family physician Medecin de famille canadien, 63(2), 131–132.
Malaty, H. M., Fraley, J. K., Abudayyeh, S., Fairly, K. W., Javed, U. S., Aboul-Fotouh, H., Mattek, N., & Gilger, M. A. (2009). Obesity and gastroesophageal reflux disease and gastroesophageal reflux symptoms in children. Clinical and experimental gastroenterology, 2, 31–36. https://doi.org/10.2147/ceg.s4715
Mezoff, E. A., & Cohen, M. B. (2013). Acid suppression and the risk of Clostridium difficile infection. The Journal of pediatrics, 163(3), 627–630. https://doi.org/10.1016/j.jpeds.2013.04.047
Rybak, A., Pesce, M., Thapar, N., & Borrelli, O. (2017). Gastro-Esophageal Reflux in Children. International journal of molecular sciences, 18(8), 1671. https://doi.org/10.3390/ijms18081671