Gold B D
Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Emory University School of Medicine, Ridgewood Drive, Atlanta, GA 30322, USA.
Aliment Pharmacol Ther. 2004 Feb;19 Suppl 1:22-7. doi: 10.1111/j.0953-0673.2004.01832.x.
The management of gastro-oesophageal reflux disease (GERD) continues to garner vast amounts of attention among physicians who care for adults. However, there is an increasing awareness of the fact that this disease, as well as several other lifelong digestive diseases (i.e. Crohn's disease) may actually have their origins in childhood. Paediatric gastro-oesophageal reflux (GER) is likely to share a similar pathophysiology to adult GER, and mounting evidence from published preliminary data suggests a genetic susceptibility to GERD. However, further studies will be necessary to confirm this hypothesis. In children, GER has a distinct presentation from that in adults, with the diagnostic work-up based upon the patient's age as well as their presenting signs and symptoms. Like their adult counterparts, the early detection and treatment of GER in children may result in a better long-term outcome, improved quality-of-life, and a reduction in overall healthcare burden. While the treatment of GER in infants tends to be conservative (i.e. positioning during feeding, smaller feedings), its management in older children parallels that of adults and includes lifestyle changes and pharmacological therapy. However, with persistent symptoms, acid suppression is the mainstay of GERD management in both children and adults. Several studies in children have verified that acid suppression with a proton pump inhibitor is superior to histamine-2 receptor antagonists. Among the proton pump inhibitors, both lansoprazole and omeprazole have been the subject of published adult and paediatric studies demonstrating their short and long-term safety, in addition to their efficacy in a variety of oesophageal and supra-oesophageal GERD related conditions. These two proton pump inhibitors are manufactured as capsules containing enteric-coated granules that can be emptied into soft foods or liquids without compromising their pharmacological effects or pharmacokinetic properties. Lansoprazole is also available as a strawberry-flavoured suspension that is acceptable to children and as an oral disintegrating tablet.
胃食管反流病（GERD）的管理持续受到成年患者医生的广泛关注。然而，人们越来越意识到，这种疾病以及其他几种终身性消化系统疾病（如克罗恩病）实际上可能起源于儿童时期。小儿胃食管反流（GER）可能与成人GER具有相似的病理生理学，已发表的初步数据表明GERD存在遗传易感性。然而，需要进一步研究来证实这一假设。在儿童中，GER的表现与成人不同，诊断检查基于患者的年龄以及其呈现的体征和症状。与成人患者一样，儿童GER的早期检测和治疗可能会带来更好的长期结果、改善生活质量并减轻总体医疗负担。虽然婴儿GER的治疗往往较为保守（如喂养时的体位、少量喂食），但大龄儿童的GER管理与成人相似，包括生活方式改变和药物治疗。然而，对于持续症状，抑酸是儿童和成人GERD管理的主要方法。多项儿童研究证实，质子泵抑制剂抑酸优于组胺-2受体拮抗剂。在质子泵抑制剂中，兰索拉唑和奥美拉唑均已成为已发表的成人和儿科研究的主题，这些研究证明了它们的短期和长期安全性，以及它们在各种食管和食管上GERD相关病症中的疗效。这两种质子泵抑制剂制成含有肠溶颗粒的胶囊，可以倒入软食或液体中而不影响其药理作用或药代动力学特性。兰索拉唑也有草莓味混悬液可供儿童使用，还有口腔崩解片剂型。
