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

Setting: Outpatient (specialty)

Study Design: Case-control

Synopsis: Gastric acid suppression in adult patients in intensive care units has been associated with the development of pneumonia. Given the common use of acid suppression in children with gastroesophageal reflux disease (GERD), the researchers conducted an exploratory study to determine if the same relationship occurs in children. They enrolled 91 consecutive children with GERD from four pediatric gastroenterology offices in Italy. Enrollment occurred over four months during the peak season for rotavirus and respiratory syncytial virus infections. The children were treated with ranitidine (Zantac) or omeprazole (Prilosec) for eight weeks. The authors only evaluated children who received at least 80 percent of the prescribed dose over the eight 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 four months of follow-up (12 versus 2 percent; number needed to harm = 11; 95% confidence interval, 3 to 135). This study design can only suggest a relationship between pneumonia and acid suppression; the design is too weak for firm conclusions. A randomized trial is needed to determine whether acid suppression, GERD, or another factor increased pneumonia risk.

Bottom Line: In this weak study, treatment of GERD with gastric acid suppressants increased the likelihood of pneumonia compared with healthy children. It is not known whether the treatment, the presence of GERD, or some other factor caused the pneumonia. (Level of Evidence: 4)