Introduction: Epidemiologic studies consistently demonstrate strong associations between gastro-esophageal reflux disease (GERD) and bronchial asthma also in children. A significant percentage of patients with GERD may experience extra-esophageal manifestations like cough or bronchspasm, which are typical symptoms of uncontrolled asthma.
Objective: retrospective analysis of prevalence and severity of GERD in children with atopic bronchial asthma and influence of proton pomp inhibitor (PPI) therapy in management of asthma.
Methods: The retrospective analysis of children with uncontrolled bronchial asthma between 6 and 18 years of age was performed. Thirty (21 boys) children were evaluated for acidic gastroesophageal reflux using 24-h esophageal pH-monitoring. Age, area of residence, presence and clinical severity of GERD, nocturnal episodes of GERD, pulmonary function parameters were analyzed. The effect of PPI therapy on modification of asthma treatment and lung function was assessed.
Results: Acidic gastroesophageal reflux was diagnosed in 17 (56%) children (fraction time of pH < 4 above 4.2%). Most of those patients (88%) came from urban area. Mean age at diagnosis of GERD was 10.5 years of age. Mild GERD was diagnosed in 13 children, moderate--in 4 children. Nocturnal episodes of reflux were present in 9 children (53%). Differences between lung function parameters (FEV1, FVC, PEF) before and after PPI treatment were not statistically significant, although their mean values were about 10% higher after treatment. PPI therapy allowed reduction of inhaled steroids dose in 24% of children; LABA were withdrawn in 3 children.
Conclusion: The association of GERD with atopic asthma in children is common. It seems to be reasonable to perform work up of pathologic GER in children with uncontrolled asthma.