Young Children Increasingly Use Medications To Treat Gastrointestinal Ailments

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The number of children taking prescription medications to treat gastrointestinal disorders has increased significantly in the past five years.

The research reviewed prescription drug claims of more than 575,000 insured children and found that the number of infants and preschoolers (4 and under) taking medications to treat gastrointestinal conditions rose almost 56 percent from 2002 to 2006, and the prevalence of elementary school-age children (5-11 year olds) using these drugs increased by 31 percent during that time frame. While the actual prevalence rate was highest among adolescents, 12-18 year olds showed the smallest increase in use of gastrointestinal medications -- rising only about 6 percent over the five year period. Based on the analysis, it's estimated that more than 2 million children in the U.S. used these drugs in 2006.

The amount spent on gastrointestinal medications also rose substantially for the pediatric group, up 50% from 2002 to 2006. The jump in spend was likely due to a combination of higher utilization and the introduction of more expensive pediatric formulations of some of these drugs. The most commonly prescribed gastrointestinal medications, proton pump inhibitors (PPIs), are now the second leading class of drugs sold in the U.S., trailing only lipid lowering medications in sales.

In addition to PPIs, Histamine-2 (H-2) blockers are also widely prescribed for children. Both these classes of medications are used to treat heartburn and gastroesophageal reflux disease (GERD) -- a condition in which harsh stomach acid backs up into the esophagus, as well as other gastrointestinal ailments.

"This analysis does raise questions about why we're seeing an increase in drug treatment for pediatric gastrointestinal disorders," said Renee Jenkins, M.D., FAAP, President-Elect of the American Academy of Pediatrics. "The growth in obesity in children may very well be contributing to a greater number of children with GERD. Diet, and stress and anxiety experienced by youngsters may also be a factor."

While reflux is common in babies during the first 3 months of life, symptoms usually cease between 12 to 24 months and only a very small number of children have symptoms severe enough to warrant drug treatment. However, recent studies have shown a link between obesity and GERD in adults, a connection that may also be affecting children and could explain why these medications are growing in use among the pediatric population. More than 10 percent of preschoolers and 30 percent of children are now considered overweight in the U.S.

"While abdominal pain is common in childhood and adolescence, rarely is it caused by disease," continued Dr. Jenkins. "The use of medications may be appropriate in some cases but it's important to try and identify and address the primary cause of the problem; if it's related to weight and diet, lifestyle changes should suffice. If there is a psychological reason, behavioral techniques or counseling may be the best approach."

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Reflux in infants is extremely common and in most cases can be overlooked or treated with changes in diet or feeding. In extreme cases, gastrointestinal medications including PPIs and H2 blockers may be recommended.

"We have seen an increasing trend in the use of PPIs and H-2 blockers for infants," said Dr. Robert Epstein, chief medical officer for Medco. "While there are babies that do require drug treatment for extreme cases of GERD and other gastrointestinal problems, in some cases parents and physicians may be looking to medications when non-drug treatments might be adequate."

A patient's overall medication use has to be considered when treating heartburn and GERD in adults and children alike. Over-the-counter antacids can interact with many different pharmaceuticals and patients with heart disease, high blood pressure or a kidney disorder should consult with their doctor before choosing an antacid.

Non-drug treatments for treating GERD include eating smaller, more frequent meals; avoiding food 2 to 3 hours before bed; using an elevated sleep position with the head at a 30 degree angle; and no carbonated drinks, chocolate, caffeine, and food that are high in fat or are very acidic or spicy.

Medco's Pediatric Focus

For more than five years, Medco has been bringing to the public forefront pediatric prescription drug trends, issues and concerns. The company's vigilance in this area has contributed to a growing awareness of increased utilization of these medications among children and has been instrumental in furthering the discussion of the factors behind this development, especially in the area of behavioral medications.

To help ensure that gastrointestinal medications are being utilized properly in the pediatric population, Medco uses a number of drug utilization review (DUR) rules to assess if the drug is appropriate given the age of the patient and if the prescribed dosage is correct.

"While drug therapy is essential for certain patients, the risks and benefits must always be weighed and, when clinically appropriate, non-drug treatments and like lifestyle modifications should be the initial approach," said Epstein. "When medication is necessary, parents should ask their children's physician about generics and over-the-counter options, which could result in cost savings."

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