Most babies have some degree of reflux, which is the involuntary passage of stomach content back into the esophagus. A group of babies will develop gastroesophageal reflux disease (GERD), where they'll have symptoms of pain, colic-like crying, recurrent vomiting, irritability, cough, feeding refusal and arching of their backs. For babies with GERD symptoms there are several treatment alternatives including pharmacologic therapy.
H2 Blockers
H2 blockers are medicines that block histamine receptors in the stomach. When histamine attaches to H2 receptors in the stomach it stimulates the stomach cells to produce acid. H2 blockers prevent histamine from attaching to these receptors, therefore reducing the amount of acid produced by the stomach. Common H2 blockers used in babies with reflux include Zantac (ranitidine), Tagamet (cimetidine) and Pepcid (famotidine). These medicines are first line therapy for babies with GERD.
Proton Pump Inhibitors
Proton pump inhibitors are more effective than H2 blockers in the treatment of GERD in babies, and are used as a second line therapy when H2 blockers do not produce the desired results. Proton pump inhibitors, or PPIs, work by decreasing the functionality of the proton pump in the stomach cells. The proton pump secretes hydrogen, the principal component of stomach acid. Proton pump inhibitors block the action of the pump, virtually shutting down acid production in the stomach. Common PPIs used in babies include Prilosec (omeprazole), Prevacid (lansoprazole), Nexium (esomeprazole), and Protonix® (pantoprozole).
Prokinetic Agents
Prokinetics are medicines that speed up the movement of food through the digestive tract. H2 blockers and proton pump inhibitors aim to reduce the acidity in the stomach in order to decrease symptoms, while not acting on the actual physical reflux of stomach contents. Prokinetic medicines aim to reduce reflux by getting food out of the stomach faster. Most common prokinetics are erythromycin, an antibiotic, which, at low doses, increases gastric motility; and metoclopramide, which coordinates the motility of the esophagus, stomach and intestines.
