weekly_question 4/2/2024

[Admin]

A 10 month old, former term infant boy with a history of long gap EA repair at another institution (done at the age of 4m after initial gastrostomy at birth) is on PPI for GERD. baby is complaining of infrequent attacks of Choking and regurgitation without weight loss and on upper GI study there is severe reflux but no stricture. baby sent to you by primary care physician for evaluation for fundoplication (as a second opinion after Primary surgeon is advising only using PPI). you advised doing fundoplication. The MOST compelling reason to stop the proton pump inhibitor and doing fundoplication, as soon as reasonably possible, is due to the potential increased risk of:

A Clostridium Difficile infection

B Meningitis

C Pneumonia

D Necrotizing enterocolitis

E Fractures

[Admin]

Correct answer
C Pneumonia

Proton pump inhibitors (PPI) and histamine-2 (H2) blockers are frequently prescribed to treat reflux in infants, but serious concerns exist regarding the long-term effects of these drugs. Current recommendations call for use of PPIs with greater caution in infants and using as short a course as possible. While all the conditions listed have been associated with PPI use in infants, Level I data links the risk of PPIs to community acquired pneumonia and gastroenteritis in infants. While C difficile infection is a definite risk in older patients, this typically is not a pathogen in infants. An increased risk of necrotizing enterocolitis and meningitis has been shown in low-birth-weight preterm infants who receive acid suppression therapy (specifically H2 blockers). However, in an older term infant developing NEC is not as much of a concern. While fractures were thought to be mostly of theoretical risk, a 2019 retrospective cohort study demonstrated that infants started on PPIs had a younger age at first fracture (3.9 vs 4.5 years) and after adjustment, an increased fracture hazard (21%), which further increased if both H2 blockers and PPIs were given (30%). While these data are compelling, the level of evidence they provide does not rise to that shown linking PPI use in infancy to infections (prospective high quality data, although smaller populations).

[Yyousef]

E fractures as proton pump inhibitors stop vit D absorption causing osteopenia.

[Bilal]

E

[Manal Dhaiban]

C

[zeedu5050]

E

[Ismailmohamed]

A

[Ahmed Rabie]

E

[Amal Adam]

E

[Aziza Elnaeema]

E

[Bashar Qassas]

A und E

[Ahmad Alsari]

C

[Admin]

Correct answer
C Pneumonia

Proton pump inhibitors (PPI) and histamine-2 (H2) blockers are frequently prescribed to treat reflux in infants, but serious concerns exist regarding the long-term effects of these drugs. Current recommendations call for use of PPIs with greater caution in infants and using as short a course as possible. While all the conditions listed have been associated with PPI use in infants, Level I data links the risk of PPIs to community acquired pneumonia and gastroenteritis in infants. While C difficile infection is a definite risk in older patients, this typically is not a pathogen in infants. An increased risk of necrotizing enterocolitis and meningitis has been shown in low-birth-weight preterm infants who receive acid suppression therapy (specifically H2 blockers). However, in an older term infant developing NEC is not as much of a concern. While fractures were thought to be mostly of theoretical risk, a 2019 retrospective cohort study demonstrated that infants started on PPIs had a younger age at first fracture (3.9 vs 4.5 years) and after adjustment, an increased fracture hazard (21%), which further increased if both H2 blockers and PPIs were given (30%). While these data are compelling, the level of evidence they provide does not rise to that shown linking PPI use in infancy to infections (prospective high quality data, although smaller populations).