RESUMO
OBJECTIVE: To characterize those pediatric patients who receive long-term proton pump inhibitors (PPIs) and to determine the safety of long-term use of PPIs in this population. STUDY DESIGN: Patient databases were screened for long-term PPI use, defined as more than 9 months of continuous prescription, between 1989 and 2004. RESULTS: The median duration of PPI use in the 166 patients in the study group was 3 years (range, 0.75 to 11.25 years). A total of 80 patients used PPIs for 3 to 11 years duration; 35 of these for more than 5 years, and 15 for more than 8 years. Mean age at initial prescription was 7.8 years. At least 1 gastroesophageal reflux disease (GERD)-predisposing disorder was present in 79% of the patients; the major disorders were neuromotor (in 66%) and esophageal atresia (in 14.5%). No GERD-predisposing disorder was present in 35 patients (21%). Endoscopic findings included hiatal hernia in 39% and histologically proven Barrett's esophagus in 4.8%. Omeprazole was used in 90% of the patients; lansoprazole, in 7%. Six adverse reactions seen in 4 patients were potentially related to PPI (nausea and diarrhea, skin rash, agitation, and irritability). CONCLUSIONS: Children with underlying GERD-predisposing disorders compose the majority of long-term PPI users. Few adverse reactions to these drugs occur, and discontinuation of the drug is seldom indicated. These preliminary data suggest that PPIs may be efficacious and safe for continuous use for up to 11 years' duration in children.
Assuntos
Refluxo Gastroesofágico/tratamento farmacológico , Inibidores da Bomba de Prótons , Bombas de Próton/efeitos adversos , 2-Piridinilmetilsulfinilbenzimidazóis/efeitos adversos , 2-Piridinilmetilsulfinilbenzimidazóis/uso terapêutico , Distribuição por Idade , Criança , Pré-Escolar , Estudos de Coortes , Diarreia/induzido quimicamente , Diarreia/epidemiologia , Relação Dose-Resposta a Droga , Esquema de Medicação , Exantema/induzido quimicamente , Exantema/epidemiologia , Feminino , Refluxo Gastroesofágico/congênito , Gastroscopia , Humanos , Incidência , Lactente , Lansoprazol , Assistência de Longa Duração , Masculino , Náusea/induzido quimicamente , Náusea/epidemiologia , Omeprazol/efeitos adversos , Omeprazol/uso terapêutico , Probabilidade , Prognóstico , Bombas de Próton/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Vômito/induzido quimicamente , Vômito/epidemiologiaRESUMO
Se describen 22 niños con ALTE, sigla que en inglés define un episodio de aparente amenaza a la vida, estudiados entre el 1o de enero de 1989 y el 30 de junio de 1991. Fueron valorados mediante neumocardiografía, electroencefalograma, imagenología para reflujoy otros exámenes según la clínica del paciente. En 32 por ciento de los niños se llegó al diagnóstico definitivo de apnea infantil, en 23 por ciento al de reflujo, en 23 por ciento al de infección respiratoria viral y en 25 por ciento se llegó a otros diagnósticos. Los pacientes recibieron tratamiento habitual de acuerdo a la patología diagnosticada, siete niños fueron monitorizados en el hogar y 11 recibieron teofilina. Ningún paciente murió. Se concluye que los niños que se presentan con episodio de ALTE deben ser exhaustivamente evaluados para identificar la causa y evaluar el posible tratamiento. La combinación de monitorización en el hogar, teofilina o tratamiento específico puede resultar salvadora para estos infantes.
Assuntos
Humanos , Recém-Nascido , Lactente , Apneia/classificação , Apneia/diagnóstico , Apneia/tratamento farmacológico , Apneia/etiologia , Refluxo Gastroesofágico/congênito , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/tratamento farmacológicoAssuntos
Junção Esofagogástrica/cirurgia , Fundo Gástrico/cirurgia , Refluxo Gastroesofágico/cirurgia , Anormalidades Múltiplas , Adolescente , Criança , Pré-Escolar , Feminino , Refluxo Gastroesofágico/congênito , Gastrostomia , Humanos , Lactente , Recém-Nascido , Masculino , Métodos , México , Complicações Pós-Operatórias/mortalidade , Recidiva , Estudos RetrospectivosRESUMO
Respiratory distress, apnea, and chronic pulmonary disease since birth were identified in 14 infants who also had symptomatic gastroesophageal reflux. Birth weights varied from 760 to 4,540 gm. All infants had radiographic changes similar to those in bronchopulmonary dysplasia. Cessation of apnea and improvement of pulmonary disease occurred only after medical (8) or surgical (6) control of gastroesophageal reflux. Simultaneous tracings of esophageal pH, heart rate, impedance pneumography, and nasal air flow in five infants demonstrated that reflux preceded apnea. Apnea could be induced by instillation of dilute acid, but not water or formula, into the esophagus. Prolonged monitoring of esophageal pH more than two hours after feeding in 14 other infants less than 6 weeks of age (birth weight 780 to 3,350 gm) without a history of recent vomiting indicated that reflux was not greater than in normal older children.