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儿童胃食管反流病治疗中报告的不良反应:一项10年的文献综述。

Adverse effects reported in the use of gastroesophageal reflux disease treatments in children: a 10 years literature review.

作者信息

Cohen Shlomi, Bueno de Mesquita Mirjam, Mimouni Francis B

机构信息

The Pediatric Gastroenterology unit.

Department of Pediatrics, 'Dana-Dwek' Children's Hospital, Tel Aviv Medical Center and, the.

出版信息

Br J Clin Pharmacol. 2015 Aug;80(2):200-8. doi: 10.1111/bcp.12619. Epub 2015 Jun 11.

Abstract

Gastroesophageal reflux (GER) is commonly observed in children, particularly during the first year of life. Pharmacological therapy is mostly reserved for symptomatic infants diagnosed with GER disease (GERD), usually as defined in a recent consensus statement. The purpose of the present article was to review the reported adverse effects of pharmacological agents used in the treatment of paediatric GERD. We conducted this review using the electronic journal database Pubmed and Cochrane database systematic reviews using the latest 10-year period (1 January 2003 to 31 December 2012). Our search strategy included the following keywords: omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole, rantidine, cimetidine, famotidine, nizatidine, domperidone, metoclopramide, betanechol, erythromycin, baclofen, alginate. We used Pubmed's own filter of: 'child: birth-18 years'. All full articles were reviewed and we only included randomized controlled trials retrieved from our search. We addressed a summary of our search on a drug-by-drug basis with regard to its mechanism of action and clinical applications, and reviewed all of the adverse effects reported and the safety profile of each drug. Adverse effects have been reported in at least 23% of patients treated with histamine H2 receptor antagonists (H2 RAs) and 34% of those treated with proton pump inhibitors (PPIs), and mostly include headaches, diarrhoea, nausea (H2 RAs and PPIs) and constipation (PPIs). Acid suppression may place immune-deficient infants and children, or those with indwelling catheters, at risk for the development of lower respiratory tract infections and nosocomial sepsis. Prokinetic agents have many adverse effects, without major benefits to support their routine use.

摘要

胃食管反流(GER)在儿童中很常见,尤其是在生命的第一年。药物治疗主要用于诊断为胃食管反流病(GERD)的有症状婴儿,通常按照最近的共识声明来定义。本文的目的是综述用于治疗小儿GERD的药物的报道不良反应。我们使用电子期刊数据库PubMed和Cochrane数据库系统评价,检索最近10年(2003年1月1日至2012年12月31日)的文献。我们的检索策略包括以下关键词:奥美拉唑、埃索美拉唑、兰索拉唑、泮托拉唑、雷贝拉唑、雷尼替丁、西咪替丁、法莫替丁、尼扎替丁、多潘立酮、甲氧氯普胺、氨甲酰甲胆碱、红霉素、巴氯芬、藻酸盐。我们使用PubMed自带的过滤器:“儿童:出生至18岁”。对所有全文进行了综述,我们只纳入检索到的随机对照试验。我们逐一总结了每种药物的作用机制、临床应用,并综述了报道的所有不良反应以及每种药物的安全性概况。至少23%接受组胺H2受体拮抗剂(H2RAs)治疗的患者和34%接受质子泵抑制剂(PPIs)治疗的患者报告了不良反应,主要包括头痛、腹泻、恶心(H2RAs和PPIs)和便秘(PPIs)。胃酸抑制可能使免疫缺陷的婴幼儿或留置导管的儿童有发生下呼吸道感染和医院感染败血症的风险。促动力药有许多不良反应,没有重大益处支持其常规使用。

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