Dohil R et al. (2005) Esomeprazole therapy for gastric acid hypersecretion in children with cystinosis. Pediatr Nephrol 20: 1786–1793

The sulfhydryl agent cysteamine (also known as mercaptamine) is the only available treatment for CYSTINOSIS, but is often associated with compliance-compromising overproduction of gastric acid. Results of a small prospective investigation indicate that esomeprazole—a proton-pump inhibitor—slows gastric acid secretion and improves gastrointestinal symptoms in pediatric patients.

The gastric contents of 12 children (average age 5.8 years) with cystinosis plus cysteamine-associated gastrointestinal complications were aspirated to determine basal, maximum and peak ACID OUTPUTS. Mean maximum and peak acid outputs after cysteamine ingestion were substantially higher than mean pre-cysteamine basal acid output, confirming the link between cysteamine and gastric acid hypersecretion.

Mean basal, maximum and peak acid outputs fell by more than 50% after 16 weeks of esomeprazole therapy (mean dose 1.7 mg/kg/day; P = 0.014, P <0.027 and P <0.027, respectively). Gastrointestinal symptoms, particularly those that might be acid-induced, such as pain and vomiting, also improved during this period. Mild adverse effects of esomeprazole were reported in one patient only. Importantly, esomeprazole did not significantly alter plasma levels of cysteamine.

Seven of eight children who had previously been treated with other proton-pump inhibitors—including esomeprazole's ENANTIOMER omeprazole—chose to remain on the study drug. Larger controlled trials are needed to confirm the superiority of esomeprazole for the relief of adverse gastrointestinal effects associated with cysteamine.