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228 Gastroesophageal reflux disease
adds no efficacy and incurs substantial risk of additional side effects. 3,29,30 In
fact, a 2006 meta-analysis of metoclopramide for pediatric GERD treatment
was aborted owing to lack of any conclusive evidence; the authors recommend
that metoclopramide be used with caution given growing recognition
of its adverse effects in the pediatric population. 31 The novel prokinetic agent
itopride has promising preliminary results in an open-label GERD trial, but
recommendation for its acute care use must await further data. 32
Nitrates and calcium channel blockers may have a role in pain caused by
esophageal spasm, but there is little or no evidence supporting their use in
GERD. 33
n Summary and recommendations
First line: pantoprazole 40 mg PO QD
Reasonable:
n antacids (e.g. aluminum/magnesium salts, 2–4 teaspoons or 2–4 tablets
PO, between meals and HS)
n H2-receptor antagonists (e.g. ranitidine 150 mg PO BID or 300 mg PO HS)
n sucralfate 1g PO QID (before meals and HS)
Pediatric:
n sucralfate 500 mg PO QID (before meals and HS)
n children at least 1 year of age: lansoprazole (morning dose of 15 mg/day
PO if