Acid Suppression Therapy for the Empirical Treatment of Nausea and Vomiting in Hospitalized Pediatric Patients
Objective: To investigate and compare the safety and efficacy of the empirical use of Histamine-2-receptor antagonists (H2RAs) and Proton pump inhibitors (PPIs), for the treatment of unspecified nausea and vomiting (NV) in hospitalized children.
Methods: The retrospective cohort study was conducted at King Abdulaziz Medical City in Riyadh (KAMC-R) and included pediatric patients ≤14 years who received acid suppression therapy (AST), H2RAs or PPIs, for the treatment of unspecified NV between April 30, 2018, and April 30, 2019. The primary outcome was the complete resolution of NV within three days of AST. The secondary outcomes were the frequency of rescue medication use, the number of vomiting episodes since starting the AST, and the adverse drug reactions (ADRs).
Results: Sixty-two patients were included in the study, 25 (40.3%) were in the H2RAs group and 37 (59.7%) in the PPIs group. The mean age was 3.69 ± 4.13 years, with the majority male (64.5%). Overall, 87% (n=54) of the sample had complete resolution of NV within 3 days of the AST therapy with no difference between the H2RAs and PPIs groups (p=0.344). The number of NV episodes from initiating the AST until the complete resolution was similar between the groups. In total, 14 patients (25.9%) required rescue therapy with granisetron, 6 (26.1%) in the H2RAs group compared to 8 (25.8%) in the PPIs group. There was no difference in the number of the required granisetron doses or the incidence of ADRs.
Conclusion: Both PPIs and H2RAs were effective and safe for the treatment of unspecified NV in hospitalized pediatric patients. The selection of either agent should be based on other factors.
Keywords: Pediatric; Nausea and vomiting; Proton pump inhibitor; Histamine-2-receptor antagonist; Granisetron.
2. Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004; 350(24):2441-2451. https://doi.org/10.1056/NEJMoa032196
3. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2014; 118(1):85-113. https://doi.org/10.1213/ANE.0000000000000002
4. Simon RW. Pediatric Postoperative Nausea and Vomiting: Assessing the Impact of Evidence-Based Practice Change. AANA J. 2020; 88(4):264-271.
5. Dupuis LL, Roscoe JA, Olver I, Aapro M, Molassiotis A. 2016 updated MASCC/ESMO consensus recommendations: Anticipatory nausea and vomiting in children and adults receiving chemotherapy. Support Care Cancer. 2017; 25(1):317-321. https://doi.org/10.1007/s00520-016-3330-z
6. Dupuis LL, Boodhan S, Sung L, et al. Guideline for the classification of the acute emetogenic potential of antineoplastic medication in pediatric cancer patients. Pediatr Blood Cancer. 2011; 57(2):191-198. https://doi.org/10.1002/pbc.23114
7. Frank L, Kleinman L, Ganoczy D, et al. Upper gastrointestinal symptoms in North America: prevalence and relationship to healthcare utilization and quality of life. Dig Dis Sci. 2000; 45(4):809-818. https://doi.org/10.1023/A:1005468332122
8. Parkman HP, Hasler WL, Fisher RS; American Gastroenterological Association. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004; 127(5):1592-1622. https://doi.org/10.1053/j.gastro.2004.09.055
9. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992; 77(1):162-184. https://doi.org/10.1097/00000542-199207000-00023
10. Raeder J, Dahl V, Bjoernestad E, et al. Does esomeprazole prevent post-operative nausea and vomiting?. Acta Anaesthesiol Scand. 2007; 51(2):217-225. https://doi.org/10.1111/j.1399-6576.2006.01179.x
11. Kwon YS, Choi JW, Lee HS, Kim JH, Kim Y, Lee JJ. Effect of a Preoperative Proton Pump Inhibitor and Gastroesophageal Reflux Disease on Postoperative Nausea and Vomiting. J Clin Med. 2020; 9(3):825. https://doi.org/10.3390/jcm9030825
12. Olsen KM, Bergman KL, Kaufman SS, Rebuck JA, Collier DS. Omeprazole pharmacodynamics and gastric acid suppression in critically ill pediatric transplant patients. Pediatr Crit Care Med. 2001; 2(3):232-237. https://doi.org/10.1097/00130478-200107000-00008
13. Boulay K, Blanloeil Y, Bourveau M, Geay G, Malinovsky JM. Effects of oral ranitidine, famotidine, and omeprazole on gastric volume and pH at induction and recovery from general anesthesia. Br J Anaesth. 1994; 73(4):475-478. https://doi.org/10.1093/bja/73.4.475
14. Doenicke AW, Hoernecke R, Celik I. Premedication with H1 and H2 blocking agents reduces the incidence of postoperative nausea and vomiting. Inflamm Res. 2004; 53 Suppl 2:S154-S158. https://doi.org/10.1007/s00011-004-0367-0
15. Tofil NM, Benner KW, Fuller MP, Winkler MK. Histamine 2 receptor antagonists vs intravenous proton pump inhibitors in a pediatric intensive care unit: a comparison of gastric pH. J Crit Care. 2008; 23(3):416-421. https://doi.org/10.1016/j.jcrc.2007.10.038
16. Mattos AZ, Marchese GM, Fonseca BB, Kupsi C, Machado MB. Antisecretory treatment for pediatric gastroesophageal reflux disease - a systematic review. Arq Gastroenterol. 2017; 54(4):271-280. https://doi.org/10.1590/s0004-2803.201700000-42
17. Orenstein SR. Infant GERD: symptoms, reflux episodes & reflux disease, acid & non-acid reflux--implications for treatment with PPIs. Curr Gastroenterol Rep. 2013; 15(11):353. https://doi.org/10.1007/s11894-013-0353-1
18. Safe M, Chan WH, Leach ST, Sutton L, Lui K, Krishnan U. Widespread use of gastric acid inhibitors in infants: Are they needed? Are they safe?. World J Gastrointest Pharmacol Ther. 2016; 7(4):531-539. https://doi.org/10.4292/wjgpt.v7.i4.531
19. Shields TM, Lightdale JR. Vomiting in Children. Pediatr Rev. 2018; 39(7):342-358. https://doi.org/10.1542/pir.2017-0053
20. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018; 66(3):516-554. https://doi.org/10.1097/MPG.0000000000001889
21. Hassall E. Over-prescription of acid-suppressing medications in infants: how it came about, why it's wrong, and what to do about it. J Pediatr. 2012; 160(2):193-198. https://doi.org/10.1016/j.jpeds.2011.08.067
22. Staiano, A., Quitadamo, P. Use and overuse of proton pump inhibitors. Ital J Pediatr. 2015; 41:A68 https://doi.org/10.1186/1824-7288-41-S2-A68
23. Winter H, Kum-Nji P, Mahomedy SH, et al. Efficacy and safety of pantoprazole delayed-release granules for oral suspension in a placebo-controlled treatment-withdrawal study in infants 1-11 months old with symptomatic GERD. J Pediatr Gastroenterol Nutr. 2010; 50(6):609-618. https://doi.org/10.1097/MPG.0b013e3181c2bf41
24. Orenstein SR, Hassall E, Furmaga-Jablonska W, Atkinson S, Raanan M. Multicenter, double-blind, randomized, placebo-controlled trial assessing the efficacy and safety of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease. J Pediatr. 2009; 154(4):514-520.e4. https://doi.org/10.1016/j.jpeds.2008.09.054
25. Davidson G, Wenzl TG, Thomson M, et al. Efficacy and safety of once-daily esomeprazole for the treatment of gastroesophageal reflux disease in neonatal patients. J Pediatr. 2013; 163(3):692-8.e82. https://doi.org/10.1016/j.jpeds.2013.05.007
26. Hussain S, Kierkus J, Hu P, et al. Safety and efficacy of delayed release rabeprazole in 1- to 11-month-old infants with symptomatic GERD. J Pediatr Gastroenterol Nutr. 2014; 58(2):226-236. https://doi.org/10.1097/MPG.0000000000000195
27. Ummarino D, Miele E, Masi P, Tramontano A, Staiano A, Vandenplas Y. Impact of antisecretory treatment on respiratory symptoms of gastroesophageal reflux disease in children. Dis Esophagus. 2012; 25(8):671-677. https://doi.org/10.1111/j.1442-2050.2011.01301.x
28. Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009; 49(4):498-547. https://doi.org/10.1097/MPG.0b013e3181b7f563
29. Canani RB, Cirillo P, Roggero P, et al. Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children. Pediatrics. 2006; 117(5):e817-e820. https://doi.org/10.1542/peds.2005-1655
30. Jimenez J, Drees M, Loveridge-Lenza B, Eppes S, delRosario F. Exposure to Gastric Acid-Suppression Therapy Is Associated With Health Care- and Community-Associated Clostridium difficile Infection in Children. J Pediatr Gastroenterol Nutr. 2015; 61(2):208-211. https://doi.org/10.1097/MPG.0000000000000790
31. Brown KE, Knoderer CA, Nichols KR, Crumby AS. Acid-Suppressing Agents and Risk for Clostridium difficile Infection in Pediatric Patients. Clin Pediatr (Phila). 2015; 54(11):1102-1106. https://doi.org/10.1177/0009922815569201
32. Guillet R, Stoll BJ, Cotten CM, et al. Association of H2-blocker therapy and higher incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2006; 117(2):e137-e142. https://doi.org/10.1542/peds.2005-1543
33. Saiman L, Ludington E, Pfaller M, et al. Risk factors for candidemia in Neonatal Intensive Care Unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J. 2000; 19(4):319-324. https://doi.org/10.1097/00006454-200004000-00011
34. Li Y, Xiong M, Yang M, et al. Proton pump inhibitors and the risk of hospital-acquired acute kidney injury in children. Ann Transl Med. 2020; 8(21):1438. https://doi.org/10.21037/atm-20-2284
35. Davies I, Burman-Roy S, Murphy MS; Guideline Development Group. Gastro-oesophageal reflux disease in children: NICE guidance. BMJ. 2015; 350:g7703. https://doi.org/10.1136/bmj.g7703
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