Acid suppression does not change respiratory symptoms in children with asthma and gastro-oesophageal reflux disease

Størdal, Ketil; Jóhannesdóttir, Gróa B.; Bentsen, Beint S.; Knudsen, Per Kristian; Carlsen, Karin C. Lødrup; Closs, O; Handeland, Martin; Holm, H. K.; Sandvik, Leiv

doi:10.1136/adc.2004.068890

Cited by 115 publications

(75 citation statements)

References 36 publications

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“…Para crianças com mais de 11 meses, índices de refluxo ≥ 6% são anormais 2 . Em ensaios terapêuticos, de uma forma geral, a seleção de pacientes tem sido feita a partir de índices de refluxo superiores a 5% 9,10 .…”

Section: Treatment Of Gastroesophageal Reflux Diseaseunclassified

“…Apesar de pretender comprovar se a supressão ácida foi adequada, nova pHmetria foi realizada ao final do tratamento em menos da metade dos pacientes. Nenhuma diferença foi observada entre os grupos em relação aos sintomas de asma, qualidade de vida e medidas da função pulmonar 51 .…”

Section: Asmaunclassified

“…O parâmetro clínico de melhora de sintomas esofágicos de refluxo, usado isoladamente, é falho para avaliação da adequada inibição ácida e cicatrização de mucosa esofágica. Apenas um estudo procurou identificar melhora de parâmetros da DRGE em exames diagnósticos 51 . Porém, a pHmetria esofágica ao final do tratamento foi realizada apenas em metade dos pacientes.…”

Section: Asmaunclassified

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Treatment of gastroesophageal reflux disease

Guimarães¹,

Marguet²,

Camargos³

2006

J Pediatr (Rio J)

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Objective: To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease.Sources: Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified. Summary of the findings:The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e., transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease. Conclusions:The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.J Pediatr (Rio J). 2006;82(5 Suppl):S133-45: Gastroesophageal reflux, child, drug therapy, esophagitis, respiratory tract diseases, asthma. ResumoObjetivo: Rever a literatura sobre tratamento da doença do refluxo gastroesofágico (DRGE) com ênfase nos aspectos farmacológi-cos. Identificar particularidades do tratamento farmacológico nas manifestações esofágicas e extra-esofágicas da doença.Fontes de dados: Busca eletrônica na base de dados PubMed/ MEDLINE e Cochrane Collaboration. Procurou-se identificar estudos controlados e randomizados publicados a partir de 2000, bem como revisões que representassem consensos e diretrizes publicados nos últimos 10 anos.Síntese dos dados: Nenhuma das drogas atualmente usadas no tratamento da DRGE altera comprovadamente o mecanismo principal da doença, ou seja, os relaxamentos transitórios do esfíncter esofágico inferior. O tratamento farmacológico da DRGE com sintomas ou com lesões esofágicas é baseado na inibição da secreção ácida, em particular pelos inibidores da bomba de prótons (IBP). Nas situações em que a hiper-reatividade das vias aéreas inferiores coexiste com sintomas esofágicos da DRGE, a inibição da secreção ácida deve...

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Section: Treatment Of Gastroesophageal Reflux Diseaseunclassified

Section: Asmaunclassified

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Treatment of gastroesophageal reflux disease

Guimarães¹,

Marguet²,

Camargos³

2006

J Pediatr (Rio J)

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“…The first placebo-controlled trial of omeprazole in 38 children with uncontrolled asthma and symptomatic GER showed no significant effect of omeprazole on asthma outcomes. 22 In a recent double-blind, placebo-controlled study among 306 school-age children with poorly controlled asthma, the addition of lansoprazole to anti-asthma medications for 24 weeks did not improve respiratory symptoms nor lung function, but was associated with increased adverse events; the results on asthma outcomes were similar in the subgroup with a positive pH study ('silent' GER). The differentiation between acid and non-acidic reflux regarding respiratory symptoms may be important.…”

mentioning

confidence: 57%

Asthma and Gastroesophageal Reflux Disease in Children – Completing the Puzzle

Benedictis¹,

Tocco²,

Lombardi³

2017

European Respiratory &Amp; Pulmonary Diseases

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Many findings support a possible association between gastroesophageal reflux disease (GERD) and asthma in children, but there is not enough evidence to support the causality of this association. Longitudinal studies with long-term follow-up are urgently required to cover the many gaps that persist in this area. Treatment of GERD with proton pump inhibitors (PPIs) in children with uncontrolled asthma does not substantively improve asthma outcomes but large, controlled trials in children symptomatic of both asthma and GERD are lacking. Since there are significant safety concerns for long-term PPIs use in children, physicians should carefully balance their therapeutic decisions in individual cases.

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“…2 In clinical trials, patients have been enrolled based on a reflux index greater than 5%. 9,10 Treatment of GERD The treatment of GERD should be different from that of common infantile GER. There is evidence that GERD is a lifelong condition.…”

mentioning

confidence: 99%

Tratamento da doença do refluxo gastroesofágico

Guimarães

Marguet

Camargos

2006

J. Pediatr. (Rio J.)

View full text Add to dashboard Cite

Objective: To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease.Sources: Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified. Summary of the findings:The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e., transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease. Conclusions:The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.J Pediatr (Rio J). 2006;82(5 Suppl):S133-45: Gastroesophageal reflux, child, drug therapy, esophagitis, respiratory tract diseases, asthma. The symptoms of GERD are less common than the symptoms of GER, but, even so, are very prevalent. A prevalence study reported weekly heartburn sensation and acid regurgitation in approximately 2% of children aged 3 to 9 years and in 5% to 8% of 10 to 17 year-olds. REVIEW ARTICLEHeartburn alone was identified in 17.8% of the children in the older age group. 7 In the Western world, the prevalence of GERD among adults has been estimated from 10% to 20%. 5The refluxate may be exclusively acidic or mixed with duodenum-gastric reflux. Acid reflux is easier to identify and consequently the pathophysiology, diagnosis and treatment are better known. The bile reflux is little understood, but it has been related to severe esophagitis. 8 The case of mixed reflux diagnosis is highly problematic, and is one of the limitations of pH studies. There are no specific clinical trials on mixed reflux in the literature. has not specified the classification by age group, and most of the definitions proposed are applicable to adult patients. Notwithstan...

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Acid suppression does not change respiratory symptoms in children with asthma and gastro-oesophageal reflux disease

Cited by 115 publications

References 36 publications

Treatment of gastroesophageal reflux disease

Treatment of gastroesophageal reflux disease

Asthma and Gastroesophageal Reflux Disease in Children – Completing the Puzzle

Tratamento da doença do refluxo gastroesofágico

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