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| |  Long-Term PPI Therapy in Children Has No Impact on Growth, BMD: Presented at CDDW By Cameron Johnston TORONTO -- March 2, 2010 -- A study presented on March 1 here at the Canadian Digestive Diseases Week 2010 (CDDW) suggests that while children who are being treated with long-term proton pump inhibitor (PPI) therapy face an increased risk of growth delay, their bone mineral density (BMD) is not significantly lower than what would be expected for other children their age, and there is no increased risk of fractures. According to Stephanie Willot MD, Department of Pediatric Gastroenterology, Hepatology and Nutrition, at the Sainte-Justine Hospital and the University of Montreal, Montreal, Quebec, PPIs are recognised as being safe for most patients, but large long-term studies have suggested they could lead to a thinning of bones, resulting in an increased risk of bone fractures. At the same time, these drugs are increasingly being prescribed for children who were born prematurely and have birth defects such as oesophageal atresia, which causes severe and chronic acid reflux disorder. Dr. Willot and colleagues conducted a review of 17 children (mean age, 7.8 years), 15 of whom had oesophageal atresia and had been treated with PPIs for a mean of 2.6 years at a median dose of 2.0 mg/kg/day. The results of the analysis showed that these children were generally small for their age, they weighed less, and had slightly lower BMD as measured by dual energy x-ray absorptiometry. Five patients had height measurements below normal and 5 (35%) were very low weight (in the 10th percentile) for their age. However there were no cases of traumatic fractures and none had significantly lower BMD. As Dr. Willot explained, because they were dealing with children who were small for their age, and there was a great deal of variation in the bone size measures, volumetric BMD was also measured at the lumber spine and was compared with historical data. This was found to be within the normal range for all of the children older than 4 years of age. Dr. Willot added that it does not appear that any loss in BMD was associated with either the duration of PPI therapy, or with the dose that was given. “Compared to normal reference data, our patients on chronic PPI therapy for reflux disease had normal bone mineral densities,” she said. She cautioned that this was only a pilot study, with a small population and no control group, and that the children were only followed over a limited period of time. She added that 70% of these children were also using inhaled corticosteroids, which could have had an additional impact on BMD, so it was again reassuring to see these outcomes. Dr. Willot also noted that the study only tracked fractures from trauma and did not measure for hairline fracture or microscopic fractures that could go unnoticed and yet have serious consequences in the long run. Until recently, children with oesophageal atresia have had very poor health overall, and generally had short life expectancies, so little is known about how they might fare as adults. The consequences of longer-term PPI therapy for these children still need to be evaluated, and the data in this small study cannot, in any way, predict what might happen when the children become older, said Dr. Willot. CDDW is the annual scientific conference of the Canadian Association of Gastroenterology (CAG) and the Canadian Association for the Study of the Liver (CASL). [Presentation title: Normal Bone Mineral Density in Children With Chronic Proton Pump Inhibitor Therapy for Gastro-oesophageal Reflux. Abstract A195]
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