Acid secretion from birth to adulthood.

All infants, including premature infants as young as 24 weeks' gestational age, are able to maintain an intragastric pH below 4 from the first day of life. By 24 weeks, maximal acid output approaches that in adults. In adult studies, proton pump inhibitors (PPIs) are highly effective in relieving reflux symptoms and healing reflux esophagitis. Studies are needed to evaluate PPI efficacy and appropriate dosing in infants and children. Consequences such as hypergastrinemia, bacterial overgrowth, and other potential adverse events associated with long-term PPI use also warrant evaluation in the pediatric population.