H2RAs

H2RAs decrease acid secretion by inhibiting histamine-2 receptors on gastric parietal cells. Studies of gastric pH in infants have shown more than 40% reduction in gastric acidity in infants receiving twice-daily dosing of H2RAs and more than 90% reduction in infants receiving doses 3 times a day. Pharmacokinetic studies of H2RAs in children are numerous and suggest that appropriate doses can increase gastric pH within a few hours of administration and for clinically significant periods (4–6 hours). Randomized, controlled trials in pediatric populations have also shown that H2RAs are more effective than placebo for healing esophagitis and providing symptom relief. Adverse effects of H2RAs are rare but can include irritability, headache, somnolence, and in some cases, liver disease and gynecomastia.

• In addition, H2RA use is associated with tachyphylaxis in as soon as 6 weeks and may represent a drawback to long-term use.
• If patients and/or parents report that symptoms persist, especially after a 2-week trial of a medication, reevaluate, and consider changing to or adding a different GERD pharmacological treatment strategy. For example, an infant whose symptoms have not improved after 2 weeks of H2RA therapy may be given a trial of PPI therapy.