Trends of Early Life Exposure to Acid-Suppressant Therapy in Israel during 2005-2019:
A Population-Based Study
2Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services
3Pediatric Gastroenterology & Nutrition Institute, Ruth Children’s Hospital of Haifa, Rambam Medical Center, Faculty of Medicine, Technion, Haifa, Israel
4Dana-Dwek Children’s Hospital, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Pediatric Gastroenterology Institute
Objectives and study: Proton Pump Inhibitors (PPI) and Histamine-2 Receptor Antagonists (H2RA) are part of the acid-suppressant therapy (AST) which inhibits acid secretion in the stomach and is being utilized in infants mainly for the treatment of gastroesophageal reflux disease (GERD). We aimed to describe trends in the usage of AST in a large population-based cohort.
Methods: A retrospective population-based cohort in a large state-mandated health fund in Israel. The study included all members born between 2005-2019. Patients were continuously enrolled from birth until one year of age. Exposure was defined as purchasing acid-suppressants (either Ranitidine or Omeprazole) within the first year of life. Yearly incidence rates of the first usage and the median age at onset were calculated.
Results: A total of 557,579 eligible children were detected, 20,368 of which (3.65%, 95% CI 3.60%-3.70%) purchased acid-suppressants at least once within the first year of life. The incidence rate of medication initiation demonstrated an upward trend over time with a 2.55 -fold increase from 1.82% (95% CI 1.69%-1.97%) in 2005 to 4.65% (95% CI 4.45%-4.86%) in 2019. The median age at initiation consistently decreased over time (R = -0.92, p<0.001) from 3.00 months in 2005 (IQR 1.64-5.02) to 2.49 months (IQR 1.56-3.93) in 2019.
Conclusion: There is a significant increase in AST exposure in early life during recent years with a decrease in the timing of the first usage. The effect of this change in treatment patterns on children’s health should be explored in future studies.