Prokinetic agents
Class Summary
These agents are used to augment cholinergic activity and to improve motility in the GI tract.
Metoclopramide (Reglan, Clopra, Maxolon)
Increases resting esophageal sphincter tone, improves gastric tone and peristalsis, relaxes the pyloric sphincter, and augments duodenal peristalsis with the net effect of increasing GI motility and decreasing reflux potential. Dopamine antagonist that stimulates acetylcholine release in the myenteric plexus. Acts centrally on chemoreceptor triggers in the floor of the fourth ventricle, which provides important antiemetic activity.
Bethanechol (Urecholine)
Cholinergic agent that increases tone, amplitude of contractions, peristaltic activity, and secretions of the GI tract.
Histamine (H2) receptor antagonists
Class Summary
These agents do not reduce the frequency of reflux but decrease the amount of acid in the refluxate by inhibiting acid production. All are equipotent when used in equivalent doses and work best in nonerosive esophagitis. Because of the superiority of proton pump inhibitors (PPIs), H2 blockers may be reserved for use in patients unable to tolerate PPIs.
Cimetidine (Tagamet)
Inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which, in turn, reduces gastric acid secretion, gastric volume, and reduced hydrogen concentrations.
Ranitidine (Zantac)
Inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which, in turn, reduces gastric acid secretion, gastric volume, and reduced hydrogen concentrations.
Proton pump inhibitors
Class Summary
These agents act by blocking the enzyme system responsible for active transport of protons into the GI lumen (ie, hydrogen/potassium adenosine triphosphatase [H+/K+ ATPase]) of the gastric parietal cell, also known as the proton pump.
Administer with the first meal of the day; children with nasogastric or gastrostomy tubes may have granules mixed with an acidic juice, and then the tubes are flushed to prevent blockage.
Omeprazole (Prilosec)
Inhibits gastric acid secretion. Used for the short-term treatment (4-8 wk) of GER disease.
Esomeprazole (Nexium, Nexium 24HR)
S-isomer of omeprazole. Inhibits gastric acid secretion by inhibiting H+/K+ -ATPase enzyme system at secretory surface of gastric parietal cells. Used in severe cases and in patients not responding to H2 antagonist therapy. Used for up to 4 wk to treat and relieve symptoms of active duodenal ulcers; may be used up to 8 wk to treat all grades of erosive esophagitis.
Lansoprazole (Prevacid, Prevacid Solu Tab, Prevacid 24HR)
Suppresses gastric acid secretion by specific inhibition of the (H+, K+)-ATPase enzyme system (ie, proton pump) at the secretory surface of the gastric parietal cell. It blocks the final step of acid production. The effect is dose-related and inhibits both basal and stimulated gastric acid secretion, thus increasing gastric pH.
-
Chest radiograph of a child with a tracheostomy and recurrent aspiration reveals patchy infiltrates and increased interstitial markings.
-
Lateral chest radiograph of the same child as in the previous image reveals increased interstitial markings and patchy and perihilar infiltrates.
