Omeprazole treatment of children with peptic esophagitis refractory to ranitidine therapy
M. Karjoo and R. Kane
Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, Mo.
OBJECTIVE: To evaluate the cause of chronic abdominal pain lasting more
than 3 weeks in 153 patients aged 6 to 18 years (mean, 9.9 years) who had
undergone endoscopy. DESIGN: Those patients with peptic esophagitis as the
cause of their chronic pain were treated with high-dose ranitidine
hydrochloride, followed by the proton-pump inhibitor, omeprazole, for those
who did not respond to a histamine2-receptor antagonist. RESULTS:
Eighty-four percent of patients had peptic esophagitis, 3% had
Helicobacater pylori gastritis, and 3% had ulcer disease. Seventy percent
of the patients with peptic esophagitis responded to an 8-week course of
high-dose ranitidine hydrochloride (4 mg/kg per dose, twice a day or three
times a day). Of the 30% of patients who failed to respond to ranitidine
therapy, 87% responded to an 8-week course of omeprazole (20 mg/d). The
grade of esophagitis at initial endoscopy was a predictive factor for
response to ranitidine therapy. Ninety percent of patients with grade 1
esophagitis responded to ranitidine therapy vs only 43% of those with grade
3 or 4 esophagitis. Only five patients (4%) failed to respond to both
therapies; three of these subsequently underwent Nissen fundoplications.
There were no side effects of either ranitidine or omeprazole therapy.
CONCLUSIONS: These findings indicate that (1) peptic esophagitis was a
common cause of chronic abdominal pain in pediatric patients and (2)
omeprazole was effective in the treatment of esophagitis in children and
adolescents that was resistant to high-dose histamine2-receptor
antagonists.
