PPI use increases hospitalization risk in children with problems initiating swallowing
Children with oropharyngeal dysphagia who used PPIs to alleviate aspiration were at increased risk for hospitalization, according to findings recently published in JAMA Otolaryngology-Head Neck Surgery.
“Acid suppressing medications are still commonly used for empirical therapy in pediatric patients with oropharyngeal dysphagia and aspiration because of the frequent symptom overlap, (including coughing, feeding difficulties, and vomiting) between reflux and oropharyngeal dysphagia in young children,” Rachel L. Rosen, MD, MPH, of Boston Children’s Hospital, and colleagues wrote.
“There is little data to support this approach and the potential risk for increased infections in children treated with [proton pump inhibitors] may outweigh any potential benefit,” they added.
Researchers retrospectively reviewed records of 293 children aged 2 years and younger who had abnormal results on videofluoroscopic swallow studies. Of those, 149 received proton pump inhibitors. This age group was chosen because it has both the highest rate of oropharyngeal dysphagia and most frequent use of proton pump inhibitors among pediatric patients, according to researchers.
After adjustment for comorbidities, Rosen and colleagues found patients who received proton pump inhibitors had higher hospital admission rates (incidence rate ratio = 1.77; 95% CI, 1.16-2.68) and admission nights (incidence rate ratio = 2.51; 95% CI, 1.36-4.62). Patients with enteral tubes who were prescribed proton pump inhibitors were at the highest risk for hospital admission (HR = 2.31; 95% CI, 1.24-4.31).
“These results support growing concern about potential risks of proton pump inhibitors and suggest the need to reevaluate the use of pharmacologic acid suppression in children with aspiration,” Rosen and colleagues concluded.
In a related editorial, Jeremy D. Prager, MD, MBA, of the division of pediatric otolaryngology at Children’s Hospital Colorado, agreed with the potential for increased risk and provided takeaways to clinicians based on the findings.
“The first is the continued emphasis on using evidence to support medication use in otolaryngology. Sufficient evidence exists to substantially limit proton pump inhibitor use in our field. The second trend is the continued improvement in care that may be realized by improving how physicians work and communicate together,” he wrote. – by Janel Miller
Disclosures: Prager reports serving as treasurer, board member and founder’s stock owner of Triple Endoscopy. None of the other authors reported any relevant financial disclosures.