Gastric acid is good for you

I might have used that title previously, but new data published in JAMAPediatrics supports the concept. In a prospective cohort study the authors cultured fluid from gastroscopies, and bronchoscopies in children, and compared the results between those who were on acid suppression or not.

Gastric cultures were much more likely to be positive if the child was on acid suppression (46% vs 18%). This evidence supports what had been assumed, that the increase in infections which accompanies use of acid suppressants (both in RCTs and observational studies) is due to intestinal bacterial overgrowth, followed by invasive infection.

The bronchoscopies showed fewer differences, but bronchoscopically obtained broncho-alveolar lavage samples are often positive, even in healthy individuals (such a study has never as far as I know been done in children, at least I hope not, but in adult volunteers), so it would be harder to find a difference. Among multiple analyses performed on the bronchoscopy data, there was a correlation between the burden of high non-acid reflux on MII testing, and bacterial concentrations, which suggests that possibly if you reflux, you are better to have acid in order to have fewer bugs in the fluid that you reflux. Maybe.

Another line of evidence to avoid suppressing gastric acid.

In the same episode of release of on-line first articles, a systematic review of the safety and efficacy of ranitidine and similar histamine receptor antagonists in infants and children. They included 8 trials in all with about 275 children, including newborns; the final conclusion:

Evidence to support the efficacy and safety of H2RAs in infants and children is limited and of poor quality.

Released at the same time is an editorial, the opening paragraph of which ends with the following summary phrase :

With a growing body of literature that illustrates a lack of efficacy and alarming adverse effects, there is increasing reason to limit the empirical use of acid suppression therapy in children

And, after outlining the new articles ends with a paragraph which includes the following phrases, which I cannot help but agree with:

Evidence supporting the effectiveness of H2RAs and PPIs in raising gastric pH is undoubtedly strong but evidence supporting the efficacy for symptom treatment is not…… It is becoming clearer that in many circumstances, prescribing acid-reducing medication in infants is doing no good and increasing the risk of harm.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research and tagged . Bookmark the permalink.

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