Prevalence and treatment of silent gastro-oesophageal reflux in children with recurrent respiratory disorders

Abstract

Thirty-six infants and children presenting with recurrent respiratory disorders (RRD) as the sole clinical symptom including bronchial asthma (6), recurrent obstructive bronchitis with or without wheezing (18), chronic nocturnal cough (3), recurrent episodes of pneumonia (3), recurrent pharyngitis (3) and recurrent laryngitis (3) were investigated for associated gastro-oesophageal reflux (GER) by oesophagram, endoscopy and continuous 24 h pH monitoring of the distal oesophagus. The pH monitoring criteria were selected on the basis of a preliminary study comparing statistically measurements of 32 variables recorded in 15 patients who all had clinical, radiological and endoscopic evidence of GER and in 8 asymptomatic controls. Although patients with symptomatic GER differed significantly from the asymptomatic ones for 27 variables examined, 6 variables emerged as having the highest value for discrimination (overlap score 0-1). Among these, the Euler-Byrne index (number of reflux pH less than 4 + 4 times the number of reflux episodes of more than 5 min), the percentage of total reflux time and the number of reflux episodes 1 h post-cibal scored 0 (no overlap). GER was considered to be present when at least five of these six parameters were abnormal. The overall incidence of GER in children with RRD was 41% (15) when detected by oesophagram and 61% (22) when diagnosed by pH monitoring criteria. In the children with bronchial asthma or with recurrent laryngitis, the percentage of reflux time during sleep was about 40 times higher than in asymptomatic controls and 2 times higher than in those with symptomatic GER.(ABSTRACT TRUNCATED AT 250 WORDS)

GERD or not GERD: the fussy infant

“…In some studies, approximately 60% of children with asthma had abnormal pH monitoring studies. 16,17 Unfortunately, pH monitoring does not detect nonacid reflux episodes that occur frequently in infants. Multichannel monitoring that will detect nonacidic reflux as well is being recommended for neonates.…”

Lipid-laden macrophages in induced sputum are a marker of oropharyngeal reflux and possible gastric aspiration

“…Reflux of acidic gastric contents causing parenchymal and interstitial lung disease is thought to be common [1,2], particularly in elderly debilitated patients [3] and children [4,5]. Gastro-oesophageal reflux (GOR) may be associated with pulmonary microaspiration [6] and may also contribute to the pathogenesis of cough [7,8] and asthma [9].…”

Lipid-laden alveolar macrophages (LLAM): A useful marker of silent aspiration in children

“…While conservative therapy with antacids and H-2 blockers may be useful in treating RARD in children suffering from vagally mediated bronchospasm, we are convinced that in patients with silent aspiration, esophageal surgery is indicated. 5 Medical treatment often fails in this group of patients, and relapse rates are about 70-90%. 1,24,25 Improvement after surgery 26 and good long-term results 27-29 justify surgery.…”

“…Gastroesophageal reflux (GER) is associated with pulmonary diseases such as recurrent pneumonia, 1,2 recurrent obstructive bronchitis, 3 asthma, 4,5 chronic nocturnal cough, 6 and near-miss sudden infant death syndrome. 7,8 Although this association is well-documented, the clinical management of GER remains difficult.…”