Study: Acid reducers may pose risk for children

Proton pump inhibitors (PPIs) — such as Prilosec, Protonix and Nexium — have long been among the most prescribed medications in the country to help reduce stomach acid.

The use of these medicines among children is on the rise and so are potential side effects, which is sparking concern according to a recent study published in Pediatrics.

The study, led by Sara Van Driest, MD, PhD, assistant professor of Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt, examined DNA from patients up to 3 years old at the time of PPI exposure.

 “PPIs are commonly used in children to treat gastrointestinal disorders, and we are seeing an increase in the number of adverse infection events associated with their use,” said Van Driest, the principal investigator of the study.

There is a specific enzyme in the body, CYP2C19, that helps break down these medications. The enzyme works differently in each person —slow, normal, fast or sometimes not at all — impacting the ability of the medication to be safely metabolized.

Because CYP2C19 inactivates PPIs, genetic variants that decrease the enzyme’s function may increase the medicine levels in the body leading to more infection events. Stomach acid naturally protects the body from dangerous organisms that can be found in water and food. Reducing stomach acid may increase an infant’s risk of these kinds of infections.

The study included 670 PPI-exposed infants, both healthy and those with chronic health conditions, with varying levels of enzyme function. 

The team hopes its findings will help clinicians make the best decisions on prescribing PPIs in children.

Van Driest’s team included members from the Department of Pediatrics, Biomedical Informatics, Medicine and Pharmacology from Vanderbilt, as well as one member of the Nemours Children’s Health System in Florida.

by Jessica Pasley 

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