October 2014

Efficacy and Safety of Histamine-2 Receptor Antagonists

Author Affiliations
  • 1Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
  • 2Dutch Cochrane Centre, Academic Medical Center, Amsterdam, the Netherlands

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JAMA Pediatr. 2014;168(10):947-954. doi:10.1001/jamapediatrics.2014.1273

Importance  Histamine-2 receptor antagonists (H2RAs) are frequently used in the treatment of gastroesophageal reflux disease (GERD) in children; however, their efficacy and safety is questionable.

Objective  To systematically review the literature to assess the efficacy and safety of H2RAs in pediatric GERD.

Evidence Review  PubMed, EMBASE, and the Cochrane database were searched for randomized clinical trials investigating the efficacy and safety of H2RAs in pediatric GERD. Two reviewers independently extracted data from the included articles. The quality of the evidence was assessed using the Grades of Recommendations, Assessment, Development, and Evaluation approach. When possible, infants and children were analyzed separately.

Findings  Eight studies with a total of 276 children (0-15 years of age) were included. Compared with the placebo, H2RAs were more effective in the reduction of symptoms in terms of histologic healing and increasing gastric pH and had a larger overall treatment effect. In infants, H2RAs were only more effective in terms of histologic healing. Comparing H2RAs with antacids, H2RAs were more effective in symptom reduction in only 1 study. H2RAs compared with proton pump inhibitors were not significantly different in any of the outcome measures. For safety analysis, data were not reported in a quantitative manner and for all outcomes, the quality of evidence was very low.

Conclusions and Relevance  Evidence to support the efficacy and safety of H2RAs in infants and children is limited and of poor quality. Well-designed placebo-controlled trials are needed before thorough conclusions can be drawn.