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March 1995

Omeprazole Treatment of Children With Peptic Esophagitis Refractory to Ranitidine Therapy

Author Affiliations

From the Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, St Louis, Mo. Dr Karjoo is now with the SUNY Health Science Center, Syracuse, NY.

Arch Pediatr Adolesc Med. 1995;149(3):267-271. doi:10.1001/archpedi.1995.02170150047007

Objective:  To evaluate the cause of chronic abdominal pain lasting more than 3 weeks in 153 patients aged 6 to 18 years (mean, 9.9 years) who had undergone endoscopy.

Design:  Those patients with peptic esophagitis as the cause of their chronic pain were treated with high-dose ranitidine hydrochloride, followed by the proton-pump inhibitor, omeprazole, for those who did not respond to a histamine2-receptor antagonist.

Results:  Eighty-four percent of patients had peptic esophagitis, 3% had Helicobacater pylori gastritis, and 3% had ulcer disease. Seventy percent of the patients with peptic esophagitis responded to an 8-week course of high-dose ranitidine hydrochloride (4 mg/kg per dose, twice a day or three times a day). Of the 30% of patients who failed to respond to ranitidine therapy, 87% responded to an 8-week course of omeprazole (20 mg/d). The grade of esophagitis at initial endoscopy was a predictive factor for response to ranitidine therapy. Ninety percent of patients with grade 1 esophagitis responded to ranitidine therapy vs only 43% of those with grade 3 or 4 esophagitis. Only five patients (4%) failed to respond to both therapies; three of these subsequently underwent Nissen fundoplications. There were no side effects of either ranitidine or omeprazole therapy.

Conclusions:  These findings indicate that (1) peptic esophagitis was a common cause of chronic abdominal pain in pediatric patients and (2) omeprazole was effective in the treatment of esophagitis in children and adolescents that was resistant to high-dose histamine2receptor antagonists.(Arch Pediatr Adolesc Med. 1995;149:267-271)