BNF for Children 2011-2012

BNFC 2011–2012 351 Gastro-intestinal system1.1 Dyspepsia and gastro-oesophagealreflux disease 351.1.1 Antacids and simeticone 361.1.2 Compound alginate preparations 381.2 Antispasmodics and other drugsaltering gut motility 391.3 Antisecretory drugs and mucosalprotectants 421.3.1 H 2 -receptor antagonists 431.3.2 Selective antimuscarinics 441.3.3 Chelates and complexes 441.3.4 Prostaglandin analogues 441.3.5 Proton pump inhibitors 451.4 Acute diarrhoea 461.4.1 Adsorbents and bulk-formingdrugs 471.4.2 Antimotility drugs 471.5 Chronic bowel disorders 481.5.1 Aminosalicylates 491.5.2 Corticosteroids 531.5.3 Drugs affecting the immuneresponse 541.5.4 Food allergy 561.6 Laxatives 571.6.1 Bulk-forming laxatives 571.6.2 Stimulant laxatives 591.6.3 Faecal softeners 611.6.4 Osmotic laxatives 611.6.5 Bowel cleansing preparations 641.6.6 Peripheral opioid-receptorantagonists 651.7 Local preparations for anal andrectal disorders 661.7.1 Soothing anal and rectal preparations661.7.2 Compound anal and rectal preparationswith corticosteroids 661.7.3 Rectal sclerosants 671.7.4 Management of anal fissures 671.8 Stoma and enteral feeding tubes 681.9 Drugs affecting intestinal secretions681.9.1 Drugs affecting biliary compositionand flow 681.9.2 Bile acid sequestrants 701.9.3 Aprotinin 701.9.4 Pancreatin 70This chapter includes advice on the drug managementof the following:Clostridium difficile infection, p. 49constipation, p. 57Crohn’s disease, p. 48food allergy, p. 56Helicobacter pylori infection, p. 42irritable bowel syndrome, p. 49malabsorption syndromes, p. 49NSAID-associated ulcers, p. 43ulcerative colitis, p. 481.1 Dyspepsia and gastrooesophagealrefluxdisease1.1.1 Antacids and simeticone1.1.2 Compound alginate preparationsDyspepsiaDyspepsia covers upper abdominal pain, fullness, earlysatiety, bloating, and nausea. It can occur with gastricand duodenal ulceration (section 1.3), gastro-oesophagealreflux disease, gastritis, and upper gastro-intestinalmotility disorders, but most commonly it is ofuncertain origin.Children with dyspepsia should be advised about lifestylechanges (see Gastro-oesophageal reflux disease,below). Some medications may cause dyspepsia—theseshould be stopped, if possible.A compound alginate preparation (section 1.1.2) mayprovide relief from dyspepsia; persistent dyspepsiarequires investigation. Treatment with a H 2-receptorantagonist (section 1.3.1) or a proton pump inhibitor(section 1.3.5) should be initiated only on the advice of ahospital specialist.Helicobacter pylori may be present in children withdyspepsia. H. pylori eradication therapy (section 1.3)should be considered for persistent dyspepsia if it isulcer-like. However, most children with functional(investigated, non-ulcer) dyspepsia do not benefit symptomaticallyfrom H. pylori eradication.Gastro-oesophageal reflux diseaseGastro-oesophageal reflux disease includes non-erosivegastro-oesophageal reflux and erosive oesophagitis.Uncomplicated gastro-oesophageal reflux is commonin infancy and most symptoms, such as intermittentvomiting or repeated, effortless regurgitation, resolve1 Gastro-intestinal system