Indian Experts' Viewpoint on Ranitidine Use in Symptoms Associated with Acid Reflux
Gastroesophageal reflux disorder (GERD) is commonly seen in both adults and children. Research data shows that GERD shows a peak incidence of 60-70% amongst 3-4 months old infants and reduces to about 5% by one year of age. (1)
A recent review of medical literature was conducted by a panel of 13 Indian experts, comprising of eminent pediatricians and pediatric gastroenterologists. Their consensus statement supports the therapeutic use of ranitidine in the pediatric population. These clinical practice recommendations have now been published in International Journal of Contemporary Pediatrics.
"Ranitidine proves to be efficacious and safe in reducing the symptoms of acid reflux in the pediatric population", this consensus paper stated.
The symptoms of GERD in children may not be as obvious as those seen in adults and thus require careful diagnosis and management.
Speaking to Medical Dialogues about the atypical presentations of GERD in infants, Dr. Uday A. Pai, Consultant Pediatrician and Neonatologist from Mumbai, who led the review panel, explained- "We see children coming with repeated bouts of vomiting, not feeding well, crying excessively and having colicky pain. When we review the parameters of growth and development of the child, the child is not thriving appropriately for their age. This is especially obvious in infancy".
He further added that GERD in infancy, can be severe enough to upset the feeding pattern of the child and push the child into a definitive deficiency of nutrition which may progress to "failure-to-thrive".
Dr. Arun Wadhwa, Senior Consultant Pediatrician from Delhi, and a panelist of the review explains that GERD is more evident in infants because they have a "lax" lower esophageal sphincter by nature.
"As they grow older, the sphincter strengthens and develops gradually and then the incidence of reflux reduces", he elaborated.
As per the recommendation, the consensus paper emphasizes that Ranitidine effectively prevents nocturnal acid reflux.
Dr. Arun Wadhwa emphasizes that the rapid onset and longer duration of action of Ranitidine make it the preferred treatment choice in cases of acid reflux, especially in pediatric age group. Additionally, its safety and ease of administration, are the other two other benefits.
"The calculation and titration of the dose of Ranitidine for an infant is much easier and more accurate in syrup form, and the medicine can be repeated every 12 hours to ensure efficacy, unlike proton pump inhibitors (PPIs), whose effect starts wearing off after 12 hours. This provides better coverage of symptoms of GERD in a child over 24 hours," he said.
Consultant Pediatric Gastroenterologist at Apollo Children's Hospital, Chennai, Dr. Dhanasekhar Kesavelu, also a member of the expert review panel, added that the use of Ranitidine is supported due to long-term evidence of the safety and efficacy of the drug in the Indian population.
"Symptoms of GERD in children are highly variable, including gastrointestinal manifestations and extra-gastrointestinal symptoms, such as cough and laryngitis. Most children need a short course of treatment with a drug that is safe, and the drug of choice, in that case, would be Ranitidine", Dr. Dhanasekhar said.
On the clinical usages of the drug, Dr. Dhanasekhar said, "Ranitidine can be used in two ways- one as "mono-therapy" where Ranitidine is used alone or it can be used as an additive drug along with PPIs-"adjunct therapy". Nocturnal reflux can be better handled using Ranitidine because its efficacy is well-proven".
Adding on the issue of dosage form, Dr. Uday Pai emphasized the need for a drug that can be administered in liquid form to children as young as 6 months.
"Reflux is more predominantly observed in infants. Ranitidine is a safe and efficacious drug, which can be given to infants and children below 1 year due to ease of administration as it is available in liquid formulation," noted Dr. Pai.
Reference:
[1] Pai UA, Kesavelu D, Shah AK, Manglik AK, Wadhwa A, Acharya B, et al. Ranitidine use in pediatrics: current evidence-based review and recommendations. Int J Contemp Pediatr 2022;9:987-97.
