ABSTRACT
The aim of this study was to investigate the efficacy and side effects of domperidone in childhood gastroesophageal reflux disease. This outcome study was done on 220 children (1month -15years) referred with reflux-related gastrointestinal and extra gastrointestinal symptoms during 3 years. Upper endoscopy with biopsy was performed in all subjects except in infants with apnea. Trial therapy was begun with domperidone (0.6mg/kg/BID) 30 minutes before meal. The efficacy and side effects were evaluated in 4-week follow up. Those free of symptom were considered as positive therapeutic response. In children with esophagitis, omeprazol was prescribed for 3 months too. Follow up continued monthly for three months and then every 3-6 months up to 2 years. Mean age of subjects was 4.99 ±3.5 years. There was no significant different between two sex(female=55%, male=45%).There was poor correlation between clinical symptoms with endoscopic and histologic findings (100%, 66.4%, 82.7%). Majority of the patients (85.5%) responded to the treatment in 4 weeks. There was no significant relationship between age, sex and clinical symptoms with response to domperidone. Although side effects were observed in 22.4%, but the most frequent side effect (15%) was loose stool .Moreover this complication (constipation) was beneficial in relieving simultaneous reflux related constipation. Serious complications such as extrapyramidal signs were observed only in 0.5%. According to this study, domperidone with few side effects can be efficient for the treatment of reflux in children with any gastrointestinal or extra- gastrointestinal symptom regardless of the sex or age group, moreover further study for finding out rare complications is suggested too.
ABSTRACT
CONTEXT: Gastroesophageal reflux disease (GERD) is a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications. Its pathophysiology, diagnosis and treatment have frequently been analyzed but it is interesting to review some aspects of the GERD refractory patients to the proton pump inhibitors treatment. The treatment encompasses behavioral measures and pharmacological therapy. The majority of the patients respond well to proton pump inhibitors treatment but 20%-42% of them may not do so well. Patients who are unresponsible to 4-8 weeks' treatment with proton pump inhibitors (omeprazole, pantoprazole, rabeprazole, lansoprazole, esomeprazole, pantoprazole-Mg) might have so-called refractory GERD. RESULTS: In some cases the patients are not real refractory because either they do not have GERD or the disease was not correctly treated, but the term refractory is still employed. Although debatable, the Brazilian GERD Consensus based upon evidences recommends as first step in the diagnosis, the upper digestive endoscopy to exclude the diagnosis of peptic ulcer and cancer and in some cases identify the presence of esophageal mucosa erosions. CONCLUSIONS: The main causes of the so-called refractory GERD are: (1) functional heartburn; (2) low levels of adherence to proton pump inhibitors treatment; (3) inadequate proton pump inhibitors dosage; (4) wrong diagnosis; (5) co-morbidities and pill-induced esophagitis; (6) genotypic differences; (7) nonacid gastroesophageal reflux; (8) autoimmune skin diseases; (9) eosinophilic esophagitis.
CONTEXTO: A doença do refluxo gastroesofágico (DRGE) é a condição que se desenvolve quando o refluxo do conteúdo gástrico provoca sintomas incômodos e/ou complicações. A fisiopatologia, o diagnóstico e o tratamento da enfermidade têm sido convenientemente estudados, mas é interessante revisar alguns aspectos dos pacientes que são aparentemente refratários, ou seja, não respondem satisfatoriamente ao tratamento com os inibidores da bomba protônica, o que ocorre em 20%-42% dos casos. Aqueles, portanto, que não apresentam resposta terapêutica a um ciclo de 4 a 8 semanas de tratamento com os inibidores da bomba protônica (omeprazol, pantoprazol, rabeprazol, lansoprazol, esomeprazol, pantoprazol-Mg) podem constituir a denominada "DRGE refratária". RESULTADOS: É importante comentar que em alguns casos os pacientes não são realmente refratários ao tratamento, mas podem efetivamente não ter o diagnóstico de DRGE ou até mesmo não terem sido corretamente tratados. Quanto ao estabelecimento diagnóstico, o Consenso Brasileiro da DRGE baseado em evidências sugere a realização da endoscopia digestiva alta como primeiro passo, com o propósito de excluir a presença de úlcera péptica e câncer, além de identificar erosões na mucosa esofágica quando presentes. CONCLUSÕES: As principais causas de DRGE refratária são: (1) pirose funcional; (2) baixos níveis de aderência ao tratamento com os inibidores da bomba protônica; (3) dosagem inadequada dos inibidores da bomba protônica; (4) erro diagnóstico; (5) presença de comorbidades e esofagite induzida por comprimidos; (6) diferenças genotípicas; (7) refluxo gastroesofágico não-ácido; (8) doenças autoimunes de pele; (9) esofagite eosinofílica.