Comparison of Pantoprazole, Omeprazole and Ranitidine in Children Requiring Acid Suppression: A Prospective Pilot Study

This study compared the safety and efficacy of enterally administered pantoprazole, omeprazole and ranitidine at raising gastric pH above 4 in children with gastroesophageal reflux disease. Children with gastrostomy tubes that were being treated with one of the three drugs were included. Caregivers were taught to measure gastric pH. Dose, time of last meal, time of last dose, and time of gastric pH were collected. Four weekly pH measurements were compared among the groups. Seventeen patients were enrolled. Six received ranitidine, 6 received omeprazole, and 5 received pantoprazole. Mean doses were: ranitidine 6.8 mg/kg/day, omeprazole 1.4 mg/kg/day and pantoprazole 1.3 mg/kg/day. Mean gastric pH was 3, 4.3, and 4 for the ranitidine, omeprazole and pantoprazole groups, respectively. Twenty-nine percent of pH readings in the ranitidine, 66% in the omeprazole, and 60% in the pantoprazole group were above 4. Comparing pH to time since last dose, ranitidine failed to routinely achieve pH > 4. Pantoprazole and omeprazole achieved this, but by 12 hours after the dose both failed to maintain pH > 4. Pantoprazole and omeprazole appear more effective at controlling gastric pH than ranitidine. Pantoprazole appears safe, however doses of 1–1.5 mg/kg/day once daily may not be effective in maintaining gastric pH > 4 in children with GERD.