Drugs are
identified as a frequent cause of new-onset dyspeptic symptoms, like upper
abdominal pain, early sense of satiety, epigastric discomfort or pain in the
upper abdomen or behind the breastbone, flatulence, nausea, and vomiting. These
symptoms are dose-dependent and individual-specific, like age, sex, genetic,
and physiological factors, and any pre-existing conditions.
The ROME IV
criteria define functional dyspepsia in adults as postprandial fullness
(3days/week), early satiety (3days/week), epigastric pain, or burning (one day
per week) lasting ≥3 months, with onset ≥6 months before diagnosis and no
structural disease. In children, similar symptoms must persist for ≥2 months,
with other conditions excluded. However, no definition exists for drug-induced
dyspepsia in either adults or children.
The EMPACIP
study, published in the May 2025 issue of Cureus, involved a panel of 24
pediatric specialists from India who evaluated the severity of dyspepsia for
the commonly prescribed drugs. They emphasized that Non-Steroidal
Anti-Inflammatory Drugs (NSAIDs) like ibuprofen and mefenamic acid, combined
with paracetamol, are linked with severe dyspeptic symptoms in children, while
antimicrobials, corticosteroids, and iron or zinc supplements also contribute
to these symptoms, but to a lesser extent.
For managing
drug-induced dyspepsia in children, avoiding the responsible drug is preferred.
Acid-reducing medications (ARMs) and prokinetics are first-line options. Among
ARMs, Proton Pump Inhibitors (PPIs) are most commonly prescribed, but evidence
is limited. PPIs should be reserved for high-risk cases as their combination
with NSAIDs or steroids increases side effects, disrupts bone metabolism, and
raises fracture and infection risks, so they should be cautiously prescribed.
Histamine-2
Receptor Antagonists (H2RAs) are proposed as promising alternatives to PPIs due
to their rapid action and safety profile. The panel of 24 pediatric specialists
from India also supported the use of H2RAs for managing drug-induced dyspepsia
with following recommendations:
1. Drug-induced dyspepsia includes symptoms like bothersome postprandial
fullness, early satiety, epigastric pain, or burning after starting a new
medication.
2. Routine
prophylactic ARM use with dyspepsia-inducing medications is not recommended.
3. ARMs
should be used on an as-needed basis, initiated when symptoms arise, and
discontinued within 72 hours after resolution.
4. H2RAs
(ranitidine, famotidine) are preferred over PPIs due to their rapid onset of
action.
Effectiveness
of H2RAs in managing drug-induced dyspepsia in childrenDr. Somashekara H.R, Consultant Pediatric Gastroenterologist & Hepatologist Rainbow Children’s Hospitals Chennai and Bangalore, said, “In cases of drug-induced dyspepsia,
the need is for immediate symptom control. H2 receptor antagonists (H2RAs)
offer rapid action, making them highly valuable in such situations. I routinely
co-prescribe an H2RA whenever a medication is likely to cause gastritis. They
are useful, effective and fast-acting.”
Deciding on
co-prescribing H2RAsDr Utkarsh Bansal, Pediatrician, Om Child Care and Vaccination Clinic,
Lucknow, said, “In pediatric practice, deciding whether to
co-prescribe an acid-reducing medication (ARM) requires a careful balance
between symptom relief and the risk of over-prescription. My approach follows
these core principles:
1.
Identifying High-Risk Medication Classes: like NSAIDs (and their combinations),
specific antibiotics (Amoxicillin/Clavulanic acid, Azithromycin, Cefuroxime),
and corticosteroids.
2.
Symptom-Driven vs. Prophylactic Use: ARMs should not be prescribed reflexively
or ‘just in case.’ Instead, I follow the guideline that ARMs should be used for
drug-induced dyspepsia only when symptoms actually occur. This avoids
unnecessary medication exposure in children.
3.
Preference for H2RAs (like Ranitidine) for Rapid Relief: When co-prescription
is necessary, H2RAs are preferred due to their rapid action and safety profile.
4. Defined
Duration of Therapy: The use of ARMs need to be limited in duration and
generally stopped within 72 hours once the symptoms are managed.”
H2RAs,
a safer alternative to PPIs for pediatric patients with drug-induced dyspepsiaDr Arun Wadhwa, Pediatrician, Dr Wadhwa’s Clinic, Delhi, said, “We have been
using H2 receptor antagonists (H2RAs) for many years. They are a safer
alternative and can be used even in small children, including neonates. They
provide immediate relief and are generally well tolerated. It is a gentle acid
suppressant relevant for children.”
The study
reiterates that PPIs should be prescribed with caution and reserved for
high-risk cases, while H2RAs such as ranitidine are considered safer
alternatives for managing drug-induced dyspepsia in children.