Use of proton pump inhibitors is associated with fractures in young adults: a population-based study
OBJECTIVE To characterize those pediatric patients who receive long-term proton pump inhibitors (PPIs) and to determine the safety of long-term use of PPIs in this population. STUDY DESIGN Patient databases were screened for long-term PPI use, defined as more than 9 months of continuous prescription, between 1989 and 2004. RESULTS The median duration of PPI use in the 166 patients in the study group was 3 years (range, 0.75 to 11.25 years). A total of 80 patients used PPIs for 3 to 11 years duration; 35 of these for more than 5 years, and 15 for more than 8 years. Mean age at initial prescription was 7.8 years. At least 1 gastroesophageal reflux disease (GERD)-predisposing disorder was present in 79% of the patients; the major disorders were neuromotor (in 66%) and esophageal atresia (in 14.5%). No GERD-predisposing disorder was present in 35 patients (21%). Endoscopic findings included hiatal hernia in 39% and histologically proven Barrett's esophagus in 4.8%. Omeprazole was used in 90% of the patients; lansoprazole, in 7%. Six adverse reactions seen in 4 patients were potentially related to PPI (nausea and diarrhea, skin rash, agitation, and irritability). CONCLUSIONS Children with underlying GERD-predisposing disorders compose the majority of long-term PPI users. Few adverse reactions to these drugs occur, and discontinuation of the drug is seldom indicated. These preliminary data suggest that PPIs may be efficacious and safe for continuous use for up to 11 years' duration in children.