Does gastric acid suppression increase the risk of pneumonia in children?

In this weak study, treatment of gastroesophageal reflux disease (GERD) with gastric acid suppressants increased the likelihood of pneumonia compared with the rate in healthy children. It's not known whether the treatment, the presence of GERD, or some other factor caused the pneumonia. Watch for confirmation in randomized research. (LOE = 4)

Canani RB, Cirillo P, Roggero P, et al, for the Working Group on Intestinal Infections of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). Therapy with gastric acidity inhibitors increases the risk of acute gastroenteritis and community-acquired pneumonia in children. Pediatrics 2006 May;117:e817-820.  [PMID:16651285]

Case-control

Foundation

Outpatient (specialty)

Gastric acid suppression in intensive care unit adult patients has been associated with the development of pneumonia. Given the frequent use of acid suppression in children with GERD, these researchers conducted an exploratory study to determine if the same relationship occurs in children. They enrolled 91 consecutive children with GERD seen in 4 pediatric gastroenterology offices in Italy. Enrollment occurred over a 4-month period during the peak season for rotavirus and respiratory synctial virus infections. The children were treated with either ranitidine (Zantac) or omeprazole (Prilosec) for 8 weeks. The authors only evaluated children who received at least 80% of this dose over the 8 weeks of treatment. Healthy children seen for routine examination were recruited during the same period as a control group. There was no effort made to match the children in the control group to the treated patients. The median age of the children in both groups was 10 months. Pneumonia was diagnosed by the treating physician and verified by masked review of chest radiographs. Significantly more children receiving acid suppression therapy experienced pneumonia during the 4 months of follow-up (12% vs 2%; number needed to treat to harm = 11; 95% CI, 3 - 135). This study design can only suggest a relationship between pneumonia and acid suppression; the design is too weak for firm conclusions. We need a randomized trial to determine whether it is the acid suppression, the GERD, or something else that increased the pneumonia risk.