Omeprazole Use in Pediatrics and Adults

Introduction to Omeprazole Therapy

The American Thoracic Society recommends that PPIs should NOT be used when there are no clinical features of GERD such as recurrent regurgitation or dystonic neck posturing in infants 3

For severe, refractory GERD in infants with clear gastrointestinal symptoms (off-label), starting dose is 0.7 mg/kg/day, escalating up to 1.4-2.8 mg/kg/day if needed, but this represents off-label use with limited safety data 2, 3
Long-term use (>2.5 years) of omeprazole may be associated with enterochromaffin cell hyperplasia in up to 50% of children 2, 4
Serious adverse events, particularly lower respiratory tract infections, occurred more frequently with PPIs than placebo in infants 3, 4

Initial treatment of eosinophilic esophagitis in children is omeprazole 1 mg/kg twice daily (up to 40 mg twice daily) for 8-12 weeks, with maintenance therapy at 1 mg/kg/day (maximum 40 mg/day) showing 70.1% long-term histological remission over 12 months 1, 2
Omeprazole 20 mg twice daily for at least 8-12 weeks prior to histological assessment, with maintenance therapy effective in 73-81% of responders with eosinophilic esophagitis 1

Do not diagnose GERD based solely on symptomatic response to PPI without endoscopic confirmation, as symptoms overlap substantially with eosinophilic esophagitis, functional dyspepsia, and recurrent abdominal pain in pediatrics 5, 6
Clinical response to PPI does not rule out EoE; histological confirmation is required for diagnosis and monitoring 5, 6

If using PPI for EoE, do not reduce to lower doses in primary care; maintain therapeutic dosing (omeprazole 20 mg twice daily in adults) 1
If PPI therapy is deemed necessary for severe refractory GERD in infants, limit duration to 4-8 weeks maximum without further evaluation 3