Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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Influence of proton pump inhibitor therapy on intestinal inflammation assessed by fecal calprotectin in pediatric patients

  • Kim, Su Yeong (Department of Pediatrics, Chung-Ang University Hospital) ;
  • Lee, Na Mi (Department of Pediatrics, Chung-Ang University Hospital) ;
  • Yun, Sin Weon (Department of Pediatrics, Chung-Ang University Hospital) ;
  • Chae, Soo Ahn (Department of Pediatrics, Chung-Ang University Hospital) ;
  • Lim, In Seok (Department of Pediatrics, Chung-Ang University Hospital) ;
  • Choi, Eung Sang (Department of Pediatrics, Hanil General Hospital) ;
  • Yi, Dae Yong (Department of Pediatrics, Chung-Ang University Hospital)
  • 투고 : 2019.02.07
  • 심사 : 2019.07.02
  • 발행 : 2019.10.15
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초록

Background: An increase in the numbers of patients with gastrointestinal symptoms has recently been observed. Purpose: To investigate the effects of proton pump inhibitor (PPI) therapy on intestinal inflammation in children and adolescents as confirmed by clinical manifestations and objectively assessed by fecal calprotectin (FC) level measurement. Methods: Consecutive children (aged 3-18 years) who presented with gastrointestinal symptoms and were treated with or without PPI for at least 1 month were enrolled. Patients were divided into PPI and non-PPI groups. The PPI group was further subdivided by treatment duration and type of PPI used. Stool samples were collected for FC evaluation at baseline and after treatment and clinical data and FC levels were compared between the groups. Results: Fifty-one patients (15 boys, 36 girls) were enrolled in the study. The PPI group included 37 patients, while the non-PPI group included 14 patients. Clinical symptoms were not significantly different. FC levels and laboratory results, including C-reactive protein levels, white blood cell count, and absolute neutrophil count, were not statistically different before versus after PPI treatment. After treatment, FC levels decreased to 8.1 mg/kg (-575.4 to 340.3 mg/kg) in the PPI group and increased to 5.6 mg/kg (-460.0 to 186.9 mg/kg) in the non-PPI group compared to those before treatment (P=0.841). The number of patients with increased FC levels was not significantly different between the 2 groups (48.6% vs. 64.3%, P=0.363), similar to that observed in patients with an FC level > 50 mg/kg (24.3% and 7.1%, P=0.250). PPI therapy type and duration did not affect the FC levels (P=0.811 and P=0.502, respectively). Conclusion: Although we aimed to confirm the evidence of intestinal inflammation due to PPI use in children and adolescents through clinical symptoms and FC measurement, no significant changes were observed.

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참고문헌

  1. Kim SE, Park HK, Kim N, Joo YE, Baik GH, Shin JE, et al. Prevalence and risk factors of functional dyspepsia: a nationwide multicenter prospective study in Korea. J Clin Gastroenterol 2014;48:e12-8. https://doi.org/10.1097/MCG.0b013e31828f4bc9
  2. Ronkainen J, Agreus L. Epidemiology of reflux symptoms and GORD. Best Pract Res Clin Gastroenterol 2013;27:325-37. https://doi.org/10.1016/j.bpg.2013.06.008
  3. Forbes D, Lim A, Ravikumara M. Gastroesophageal reflux in the 21st century. Curr Opin Pediatr 2013;25:597-603. https://doi.org/10.1097/MOP.0b013e328363ecf5
  4. Cohen S, Bueno de Mesquita M, Mimouni FB. Adverse effects reported in the use of gastroesophageal reflux disease treatments in children: a 10 years literature review. Br J Clin Pharmacol 2015;80:200-8. https://doi.org/10.1111/bcp.12619
  5. Vela MF. Medical treatments of GERD: the old and new. Gastroenterol Clin North Am 2014;43:121-33. https://doi.org/10.1016/j.gtc.2013.12.001
  6. McCarthy DM. Adverse effects of proton pump inhibitor drugs: clues and conclusions. Curr Opin Gastroenterol 2010;26:624-31. https://doi.org/10.1097/MOG.0b013e32833ea9d9
  7. Fujimori S. What are the effects of proton pump inhibitors on the small intestine? World J Gastroenterol 2015;21:6817-9. https://doi.org/10.3748/wjg.v21.i22.6817
  8. Corleto VD, Festa S, Di Giulio E, Annibale B. Proton pump inhibitor therapy and potential long-term harm. Curr Opin Endocrinol Diabetes Obes 2014;21:3-8. https://doi.org/10.1097/MED.0000000000000031
  9. Compare D, Pica L, Rocco A, De Giorgi F, Cuomo R, Sarnelli G, et al. Effects of long-term PPI treatment on producing bowel symptoms and SIBO. Eur J Clin Invest 2011;41:380-6. https://doi.org/10.1111/j.1365-2362.2010.02419.x
  10. Malfertheiner P, Fass R, Quigley EM, Modlin IM, Malagelada JR, Moss SF, et al. Review article: from gastrin to gastro-oesophageal reflux disease--a century of acid suppression. Aliment Pharmacol Ther 2006;23:683-90. https://doi.org/10.1111/j.1365-2036.2006.02817.x
  11. Franco DL, Disbrow MB, Kahn A, Koepke LM, Harris LA, Harrison ME, et al. Duodenal aspirates for small intestine bacterial overgrowth: yield, PPIs, and outcomes after treatment at a tertiary academic medical center. Gastroenterol Res Pract 2015;2015:971582. https://doi.org/10.1155/2015/971582
  12. Sieczkowska A, Landowski P, Zagozdzon P, Kaminska B, Lifschitz C. Small bowel bacterial overgrowth associated with persistence of abdominal symptoms in children treated with a proton pump inhibitor. J Pediatr 2015;166:1310-2.e1. https://doi.org/10.1016/j.jpeds.2015.01.004
  13. Waugh N, Cummins E, Royle P, Kandala NB, Shyangdan D, Arasaradnam R, et al. Faecal calprotectin testing for differentiating amongst inflammatory and non-inflammatory bowel diseases: systematic review and economic evaluation. Health Technol Assess 2013;17:xv-xix, 1-211.
  14. Berni Canani R, Rapacciuolo L, Romano MT, Tanturri de Horatio L, Terrin G, Manguso F, et al. Diagnostic value of faecal calprotectin in paediatric gastroenterology clinical practice. Dig Liver Dis 2004;36: 467-70. https://doi.org/10.1016/j.dld.2004.02.009
  15. Bonnin Tomas A, Vila Vidal M, Rosell Camps A. Fecal calprotectin as a biomarker to distinguish between organic and functional gastrointestinal disease. Rev Esp Enferm Dig 2007;99:689-93.
  16. Ezri J, Nydegger A. Pediatrics. Fecal calprotectin in children: use and interpretation. Rev Med Suisse 2011;7:69-70.
  17. Rodrigo L. Fecal calprotectin. Rev Esp Enferm Dig 2007;99:683-8. https://doi.org/10.4321/S1130-01082007001200001
  18. Jang HJ, Park JH, Kim CS, Lee SL, Lee WM. Amino acid-based formula in premature infants with feeding intolerance: comparison of fecal calprotectin level. Pediatr Gastroenterol Hepatol Nutr 2018;21: 189-95. https://doi.org/10.5223/pghn.2018.21.3.189
  19. Hoog CM, Bark LA, Brostrom O, Sjoqvist U. Capsule endoscopic findings correlate with fecal calprotectin and C-reactive protein in patients with suspected small-bowel Crohn's disease. Scand J Gastroenterol 2014;49:1084-90. https://doi.org/10.3109/00365521.2014.920915
  20. Olsen PA, Fossmark R, Qvigstad G. Fecal calprotectin in patients with suspected small bowel disease--a selection tool for small bowel capsule endoscopy? Scand J Gastroenterol 2015;50:272-7. https://doi.org/10.3109/00365521.2014.1003395
  21. Montalto M, Santoro L, Dalvai S, Curigliano V, D'Onofrio F, Scarpellini E, et al. Fecal calprotectin concentrations in patients with small intestinal bacterial overgrowth. Dig Dis 2008;26:183-6. https://doi.org/10.1159/000116777
  22. Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, et al. Pediatric gastroesophageal reflux clinical practice guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2018;66:516-54. https://doi.org/10.1097/MPG.0000000000001889
  23. Owen DA. Gastritis and carditis. Mod Pathol 2003;16:325-41. https://doi.org/10.1097/01.MP.0000062995.72390.14

피인용 문헌

  1. Can proton pump inhibitors cause intestinal inflammation in children? vol.62, pp.10, 2019, https://doi.org/10.3345/kjp.2019.00878