***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The effectiveness of cimetidine ( 30–40 mg/ kg/day ) was evaluated in 32 children with gastroesophageal reflux disease complicated by esophagitis who entered a r and om double-blind trial for 12 weeks . Esophagitis was diagnosed in all patients by endoscopy with biopsy . Seventeen patients ( age , mean ± SD : 21.7 ± 97.65 months ) received cimetidine ( c-pts ) , and 15 ( age , mean ± SD : 29.03 ± 39.73 months ) received a placebo ( p-pts ) . All patients received intensive postural therapy . Based on clinical and endoscopic ( and histologic ) data , 12 c-pts and three p-pts were healed ( p < 0.01 ) , the condition of four c-pts and three p-pts had improved ( not statistically significant ) , and the condition of one c-pt and nine p-pts had worsened ( p < 0.01 ) . Both clinical and esophagitis scores significantly decreased only in the c-pt group , as compared with p-pts . Improvement of esophagitis was seen in all ( 100 % ) of c-pts with mild or moderate esophagitis versus 57.14 % of p-pts ( p < 0.01 ) and in 87.5 % of c-pts with severe esophagitis as compared with 25 % of the p-pt group ( p < 0.01 ) . We conclude that cimetidine is an effective agent for treatment of reflux esophagitis in children . Although gastroesophageal reflux disease in infancy has a naturally self-limited course with conservative care ( thickened feedings and posture adjustment ) , extensive pharmacologic therapy is needed in the presence of esophagitis In order to evaluate the use of sucralfate in the treatment of children with reflux esophagitis , we studied 66 children aged from 4 months to 12 years ( mean 5.9 years , SD 3.5 ) diagnosed to have gastroesophageal reflux by means of esophageal isotopic examination and radiology . An endoscopic examination was carried out in all cases . None of the patients suffered from kidney disease or had taken antacids , cimetidine , sucralfate or antirheumatic drugs in the two weeks prior to the study . Patients were divided into three groups matched according to age , grade of esophagitis , sex , nutritional state and semiology and treated with sucralfate in tablets , cimetidine , or sucralfate in suspension ; no dietetic or postural measures were used . On days 14 , 28 , 42 and 56 , clinical control was carried out and endoscopy was done on day 28 , this being repeated on day 56 if the course was not satisfactory . From the statistical analysis of the results we deduce that there are no differences between the three groups . Therefore sucralfate appears to be a useful drug for the treatment of children with esophagitis due to GER Background : Epidemiological studies have shown an association between gastro-oesophageal reflux disease ( GORD ) and asthma , and oesophageal acid perfusion may cause bronchial constriction . However , no causative relation has been proven . Aim : To assess whether acid suppression would lead to reduced asthma symptoms in children with concomitant asthma and GORD . Methods : Thirty eight children ( mean age 10.8 years , range 7.2–16.8 ; 29 males ) with asthma and a reflux index ⩾5.0 assessed by 24 hour oesophageal pH monitoring were r and omised to 12 weeks of treatment with omeprazole 20 mg daily or placebo . The groups were similar in age , gender , mean reflux index , and asthma severity . Primary endpoints were asthma symptoms ( daytime wheeze , symptoms at night , in the morning , and during exercise ) and quality of life ( PAQLQ ) . Secondary endpoints were changes in lung function and the use of short acting bronchodilators . At the end of the study a repeated pH study was performed to confirm the efficacy of acid suppression . Results : The change in total symptom score did not differ significantly between the omeprazole and the placebo group , and decreased by 1.28 ( 95 % CI −0.1 to 2.65 ) and 1.28 ( 95 % CI −0.72 to 3.27 ) respectively . The PAQLQ score increased by 0.62 ( 95 % CI 0.29 to 0.95 ) in the omeprazole group compared to 0.50 ( 95 % CI 0.29 to 0.70 ) in the placebo group . Change in lung function and use of short acting bronchodilators were similar in the groups . The acid suppression was adequate ( reflux index < 5.0 ) under omeprazole treatment . Conclusion : Omeprazole treatment did not improve asthma symptoms or lung function in children with asthma and GORD The effect of antisecretory treatment on extraesophageal symptoms of gastroesophageal reflux disease was evaluated . Seventy-eight children presenting with typical and extraesophageal symptoms of gastroesophageal reflux disease underwent a multichannel intraluminal impedance and pH monitoring ( MII/pH ) . Children with a positive MII/pH were r and omly treated with proton pump inhibitors ( PPIs ) or histamine H(2 ) -receptor antagonists ( H(2 ) RAs ) during 3 months . At the end of the treatment period , all patients were recalled . A second treatment period of 3 months was given to those patients who were not symptom-free after 3 months . Thirty-five of the forty-one ( 85.4 % ) children with a pathologic MII/pH presented with extraesophageal symptoms and were treated with PPIs ( omeprazole ; n:19 ) or H(2 ) RAs ( ranitidine ; n:16 ) for 12 weeks . After 3 months , 11/19 ( 57.9 % ) PPI-treated patients had a complete resolution of symptoms ; 6/8 nonresponders were treated with PPI for another 3 months and became all symptom-free . The other two underwent a Nissen fundoplication . Only 5/16 ( 31.2 % ) patients treated with H(2 ) RAs had a complete resolution of symptoms after 3 months ; 1/11 was treated again with H(2 ) RAs during 3 months , and 10/11 were changed to PPIs . In 3/10 , a partial resolution of symptoms was achieved , while in 7/10 , a complete remission was obtained ( P < 0.05 ) . Antisecretory reflux treatment improves extraesophageal reflux symptoms . The efficacy of PPIs is superior to that of H(2 ) RAs in these children Thirty two consecutive patients ( age range 6 months-13.4 years ) with severe reflux oesophagitis were r and omised to a therapeutic trial for eight weeks during which they received either st and ard doses of omeprazole ( 40 mg/day/1.73 m2 surface area ) or high doses of ranitidine ( 20 mg/kg/day ) . Twenty five patients completed the trial ( 12 on omeprazole , 13 on ranitidine )  . At entry and at the end of the trial patients underwent symptomatic score assessment , endoscopic and histological evaluation of the oesophagus , and simultaneous oesophageal and gastric pH measurement ; results are given as median ( range ) . Both therapeutic regimens were effective in decreasing clinical score  ( omeprazole before 24.0 ( 15 - 33 ) , after 9.0 ( 0 - 18 ) ; ranitidine before 19.5 ( 12 - 33 ) , after 9.0 ( 6 - 12 ) ) , in improving the histological degree of oesophagitis  ( omeprazole before 8.0 ( 6 - 10 ) , after 2.0 ( 0 - 60 ) ; ranitidine before 8.0 ( 8 - 10 ) , after 2.0 ( 2 - 6 ) , and in reducing oesophageal acid exposure , measured as minutes of reflux at 24 hour pH monitoring ( omeprazole before 129.4 ( 84 - 217 ) , after 44.6 ( 0.16 - 128 ) ; ranitidine before 207.3 ( 66 - 306 ) , after 58.4 ( 32 - 128 ) ) as well as intragastric acidity , measured as median intragastric pH ( omeprazole before 2.1 ( 1.0 - 3.0 ) , after 5.1 ( 2.2 - 7.4 ) ; ranitidine before 1.9 ( 1.6 - 4 ) , after 3.4 ( 2.3 - 5.3 ) ) . Serum gastrin concentration was > 150 ng/l in four patients on omeprazole and in three patients on ranitidine . It is concluded that in children with refractory reflux oesophagitis high doses of ranitidine are comparable with omeprazole for the healing of oesophagitis and relief of symptoms ; both drugs result ed in efficacious reduction of intragastric acidity and intra-oesophageal acid exposure In order to study the importance of gastro-oesophageal reflux ( GOR ) as a trigger of asthma the effect of inhibition of gastric acid secretion on asthma was assessed in a double-blind , cross-over , placebo-controlled trial over four weeks in 37 children and adolescents ( mean age 14 yrs ) with bronchial asthma .  Ranitidine 300 mg , ( 150 mg if B.W. was less than 40 kg ) was given as a single evening dose during four weeks . In previous investigations 18 of the 37 patients had been shown to have pathological GOR by 24 h pH monitoring in the oesophagus . The remaining 19 patients with normal GOR served as controls for possible effects of ranitidine on asthma , not related to reduction of GOR . A modest ( 30 % ) but statistically significant reduction of nocturnal asthma symptoms was produced by ranitidine in the patients with pathological GOR when compared to those with normal GOR . There was a significant correlation between the improvement in asthma symptoms and the degree of acid reflux . Side-effects of ranitidine were negligible . Acid reflux appears to be only a weak stimulus for bronchoconstriction in children and adolescents with bronchial asthma and pathological GOR . Further confirmative trials with more potent inhibitors of gastric acid secretion are , however , warranted Purpose Gastroesophageal reflux disease ( GERD ) occurs in pediatric patients when reflux of gastric contents presents with troublesome symptoms . The present study compared the effects of omeprazole and ranitidine for the treatment of  symptomatic GERD in infants of 2 - 12 months . Methods This study was a clinical r and omized double-blind trial and parallel-group comparison of omeprazole and ranitidine performed at Children Training Hospital in Tabriz , Iran . Patients received a st and ard treatment for 2 weeks . After 2 weeks , the patients with persistent symptoms were enrolled in this r and omized study . Results We enrolled 76 patients in the present study and excluded 16 patients . Thirty patients each were included in group A ( ranitidine ) and in group B ( omeprazole ) . GERD symptom score for groups A and B was 47.17±5.62 and 51.93±5.42 , respectively , with a P value of 0.54 , before the treatment and 2.47±0.58 and 2.43±1.15 , respectively , after the treatment ( P=0.98 ) . No statistically significant differences were found between ranitidine and omeprazole in their efficacy for the treatment of GERD . Conclusion The safety and  efficacy of ranitidine and omeprazole have been demonstrated in infants . Both groups of infants showed a statistically significant decrease in the score of clinical variables after the treatment OBJECTIVES : To evaluate the efficacy of acid-suppressive maintenance therapy for  gastroesophageal reflux disease ( GERD ) in children , after the healing of reflux esophagitis . METHODS : Forty-eight children ( median age 105 months , range 32–170 ) with erosive reflux esophagitis were initially treated with omeprazole 1.4 mg/kg/day for 3 months . Patients in endoscopic remission were assigned in a r and omized , blinded manner by means of a computer-generated list to three groups of 6-month maintenance treatment : group A ( omeprazole at half the starting dose , once daily before breakfast ) , group B ( ranitidine 10 mg/kg/day , divided in two doses ) , and group C ( no treatment ) . Endoscopic , histological , and symptomatic scores were evaluated at : T0 , enrollment ; T1 , assessment for remission at 3 months after enrollment ( healing phase ) ; T2 , assessment for effective maintenance at 12 months after T0 ( 3 months after the completion of the maintenance phase ) . Relapse was defined as the recurrence of macroscopic esophageal lesions . After the completion of the maintenance phase , patients without macroscopic esophagitis relapse were followed up for GERD symptoms 
    Output:
    
CONCLUSION Proton pump inhibitors or histamine H2 receptor antagonists may be used to treat children with gastroesophageal reflux disease , but not to treat asthma or unspecific symptoms