Distinguishing GORD from uncomplicated gastroesophageal reflux in infants can be difficult.

Up to 60-70 per cent of infants aged three to four months develop uncomplicated gastroesophageal reflux, which resolves spontaneously by 12 months and does not need proton pump inhibitors (PPIs).

Now French researchers report that PPIs increase the risk of several serious infections that need hospitalisation in young children. 

The study followed 1,262,424 children from birth for a median of 3.8 years. Of these, 48.1 per cent received a PPI and 12.0 per cent developed a serious infection. 

Allowing for confounders, PPIs increased the risk of serious infections by 34 per cent compared with controls. PPIs significantly increased the risk of infections in the digestive tract (by 52 per cent); ear, nose and throat (47 per cent); nervous system (31 per cent); lower respiratory tract (22 per cent); kidneys or urinary tract (20 per cent); and musculoskeletal system (17 per cent). 

PPIs increased the risk of bacterial and viral infections by 56 and 30 per cent respectively. The increased risk emerged in children with and without a history of severe prematurity or chronic illness (by 36 and 32 per cent respectively) and persisted for several months. The median time between PPI withdrawal and first serious infection was 9.7 months. 

“Additional research is needed to better identify high-risk populations and further investigate the effect of dose, duration and persistence of risk after treatment withdrawal,” say the authors, who concluded that PPIs “should not be used without a clear indication in this population”. The analysis did not include PPI use during hospital admission.

PPIs may increase the risk of infections by modifying gastric pH, altering the microbiota or influencing the immune system. (JAMA Pediatr doi:10.1001/jamapediatrics.2023.2900)