Study questions use of acid suppressors to curb spitting up in infants
About 65% of babies show signs of gastroesophageal reflux (GER), popularly known as spitting up, and the common treatment for it not so long ago was a good burp and a ready towel. Most babies grow out of it by their first birthday as their digestive tracts functionally mature.
However, in recent years, physicians have been increasingly prescribing powerful stomach-acid suppressors, such as proton pump inhibitors (PPIs) and histamine2 receptor antagonists (H2-blockers), to otherwise healthy infants with GER.
According to JAMA, evidence from a recent study suggests that these drugs don’t reduce symptoms of even more serious reflux conditions in infants or crying and irritability in infants that is often presumed to be a sign of reflux.
“Safety concerns have also recently emerged with new findings that suggest giving the drugs to infants younger than six months of age is associated with a higher risk of bone fractures later in childhood,” it said.
The study, which was presented as an abstract at the Pediatric Academic Societies (PAS) meeting this past May in San Francisco (the full study was in peer review as of this writing), found that children who received PPIs in the first 6 months of life had a 22% increased likelihood of fractures at a median 5.8 years following proton pump inhibitors use. “When the drugs were used in combination with histamine2 receptor antagonists (H2-blockers, ) the hazard climbed to 31%. The H2 blockers alone were not associated with a statistically significant hazard, according to the study’s lead author, US Air Force Capt Laura Malchodi, MD,” said JAMA.
The findings are “very bad news,” said Eric Hassall, MD, a pediatric gastroenterologist and emeritus professor at the University of British Columbia in Vancouver, who was not involved in the study.
“It’s a cautionary tale about a serious problem. When you are a physician and you prescribe a drug that triggers an allergic response, you know about the adverse effect right away and you can take the child off it or diminish the dose. But when the adverse effect is months or years away, you can’t necessarily connect it with the drug,” he said.
Whether the study findings will change prescribing habits remains uncertain. But for the moment, physicians in doubt can refer to the 2013 AAP management guidelines covering GER and GERD in infants, which advocate lifestyle changes, such as positioning therapy and feeding adjustments as “first-line therapy,” noting that the “overuse of PPIs in infants with reflux is a matter of great concern.”