Mattos Ângelo Zambam de, Marchese Gabriela Meirelles, Fonseca Bárbara Brum, Kupski Carlos, Machado Marta Brenner
Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brasil, Brazil.
Pontifícia Universidade Católica do Rio Grande do Sul, RS, Brazil.
Arq Gastroenterol. 2017 Dec;54(4):271-280. doi: 10.1590/S0004-2803.201700000-42. Epub 2017 Sep 21.
Proton pump inhibitors and histamine H2 receptor antagonists are two of the most commonly prescribed drug classes for pediatric gastroesophageal reflux disease, but their efficacy is controversial. Many patients are treated with these drugs for atypical manifestations attributed to gastroesophageal reflux, even that causal relation is not proven.
To evaluate the use of proton pump inhibitors and histamine H2 receptor antagonists in pediatric gastroesophageal reflux disease through a systematic review.
A systematic review was performed, using MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases. The search was limited to studies published in English, Portuguese or Spanish. There was no limitation regarding date of publication. Studies were considered eligible if they were randomized-controlled trials, evaluating proton pump inhibitors and/or histamine H2 receptor antagonists for the treatment of pediatric gastroesophageal reflux disease. Studies published only as abstracts, studies evaluating only non-clinical outcomes and studies exclusively comparing different doses of the same drug were excluded. Data extraction was performed by independent investigators. The study protocol was registered at PROSPERO platform (CRD42016040156).
After analyzing 735 retrieved references, 23 studies (1598 randomized patients) were included in the systematic review. Eight studies demonstrated that both proton pump inhibitors and histamine H2 receptor antagonists were effective against typical manifestations of gastroesophageal reflux disease, and that there was no evidence of benefit in combining the latter to the former or in routinely prescribing long-term maintenance treatments. Three studies evaluated the effect of treatments on children with asthma, and neither proton pump inhibitors nor histamine H2 receptor antagonists proved to be significantly better than placebo. One study compared different combinations of omeprazole, bethanechol and placebo for the treatment of children with cough, and there is no clear definition on the best strategy. Another study demonstrated that omeprazole performed better than ranitidine for the treatment of extraesophageal reflux manifestations. Ten studies failed to demonstrate significant benefits of proton pump inhibitors or histamine H2 receptor antagonists for the treatment of unspecific manifestations attributed to gastroesophageal reflux in infants.
Proton pump inhibitors or histamine H2 receptor antagonists may be used to treat children with gastroesophageal reflux disease, but not to treat asthma or unspecific symptoms.
质子泵抑制剂和组胺H2受体拮抗剂是儿科胃食管反流病最常用的两类处方药，但其疗效存在争议。许多患者因归因于胃食管反流的非典型表现而接受这些药物治疗，即便因果关系尚未得到证实。
通过系统评价评估质子泵抑制剂和组胺H2受体拮抗剂在儿科胃食管反流病中的应用。
进行了一项系统评价，使用MEDLINE、EMBASE和Cochrane对照试验中央注册库数据库。检索限于以英文、葡萄牙文或西班牙文发表的研究。对发表日期没有限制。如果研究为随机对照试验，评估质子泵抑制剂和/或组胺H2受体拮抗剂治疗儿科胃食管反流病，则被视为合格。仅以摘要形式发表的研究、仅评估非临床结局的研究以及仅比较同一药物不同剂量的研究被排除。数据提取由独立研究人员进行。研究方案在PROSPERO平台（CRD42016040156）注册。
在分析735篇检索到的参考文献后，23项研究（1598例随机分组患者）被纳入系统评价。八项研究表明，质子泵抑制剂和组胺H2受体拮抗剂均对胃食管反流病的典型表现有效，且没有证据表明将后者与前者联合使用或常规开具长期维持治疗有好处。三项研究评估了治疗对哮喘儿童的影响，质子泵抑制剂和组胺H2受体拮抗剂均未被证明明显优于安慰剂。一项研究比较了奥美拉唑、氨甲酰甲胆碱和安慰剂的不同组合对咳嗽儿童的治疗效果，对于最佳治疗策略尚无明确定义。另一项研究表明，奥美拉唑在治疗食管外反流表现方面比雷尼替丁效果更好。十项研究未能证明质子泵抑制剂或组胺H2受体拮抗剂对治疗婴儿因胃食管反流引起的非特异性表现有显著益处。
质子泵抑制剂或组胺H2受体拮抗剂可用于治疗患有胃食管反流病的儿童，但不能用于治疗哮喘或非特异性症状。
