The New York Times reports this week that reflux medications “may not do babies any good.” The article which appeared in the NYT weekly Health page was based on a pilot study presented at the North American Society of Pediatric Gastroenterology, Hepatology & Nutrition national meeting in Orlando. The study looked at the effect of different acid suppressant medications on acid and non-acid reflux events as measured with a special pH meter. The investigators sought to know if the suppression of acid in babies lead to less reflux? As it turns out, H2RAs (example: Axid, Zantac) didn’t decrease the number of acid reflux events experienced by the babies in the study. PPIs (example: Prevacid, Prilosec) decreased acid reflux events in babies fed by mouth but not in those fed with a feeding tube.
On the surface this study is interesting because it might suggest that the sweeping conclusion of the New York Times is correct. On the other hand these findings support what we already know: acid suppression doesn’t fix the happy spitter. It would appear, however, that PPI use might make things a little easier on a baby by minimizing acid exposure to the esophagus and throat.
The burning question: How effective are acid suppression medications at controlling the miserable symptoms of reflux esophagitis? Unfortunately the pilot data in this study don’t address this. The pediatric tummy docs of the world debate this question and the jury is still out. Given the absence of adequate research in this area most pediatric gastroenterologists have taken to treating sick reflux babies with some type of acid suppression.
Dr. Ajay Kaul and his colleagues at the University of Cincinnati should be commended for stepping up to address the questions of infant reflux. But like all good research, we wind up with as many questions as answers.