Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children.

摘要

The authors performed a prospective, controlled trial involving 91 children, ages 4 to 36 months, who were diagnosed with gastroesophageal reflux disease (GERD) by endoscopic biopsy and pH probe. They received either high-dose ranitidine (dosage, 10 mg/kg/day) or omeprazole (dosage, 1 mg/kg/day) during a 4-month study period. The authors compiled the rates of gastroenteritis and pneumonia in these acid-suppressed patients and in a cohort of 95 healthy children matched for age, sex, growth, and number of infections in the 4 months before the treatment period. Excluded were children with conditions predisposing to recurrent infection, including diabetes, chronic lung or cardiac disease, and congenital gastrointestinal motility disorders. Data were also compiled for the 4 months before the introduction of acid-suppressive therapy. Gastroenteritis was defined as the presence of diarrhea of 2 to 7 days' duration, with or without other symptoms such as fever. Pneumonia was defined as clinical symptoms confirmed with a chest radiograph. The diagnosis of these infections was prompted by self-referral-parents were instructed to contact their primary physician or the study center if symptoms developed. The study period coincided with the time of year during which Italy experiences the highest rates of rotavirus and respiratory syncytial virus infections.The control group had 19 cases of gastroenteritis compared with 43 in the treated group (P = 0.001; OR = 3.58), and 2 control pneumonias compared with 11 in the treated group (P = 0.03; OR = 6.39). The baseline infection rates in the treatment and control cohorts during the 4 months before the start of the study were the same. The increased infection rate in the treated group lasted beyond the 4 months of the study.