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Role of non‐acid gastro‐esophageal reflux in children with respiratory symptoms
Author(s) -
Zenzeri Letizia,
Quitadamo Paolo,
Tambucci Renato,
Ummarino Dario,
Poziello Antonio,
Miele Erasmo,
Staiano Annamaria
Publication year - 2017
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23619
Subject(s) - medicine , reflux , gerd , gastroenterology , respiratory system , prospective cohort study , gastro , esophageal ph monitoring , asthma , refractory (planetary science) , respiratory disease , disease , lung , physics , astrobiology
Summary Objectives Respiratory symptoms are a possible atypical clinical picture of gastro‐esophageal reflux disease (GERD). However, a significant number of patients with GERD‐related respiratory symptoms do not report improvement despite aggressive acid‐suppressive therapy. Some of these refractory cases may be due to the recently appreciated entity of non‐acid or weakly acidic reflux. The aim of our study is to assess the pH‐impedance features of GER inducing airway symptoms, compared with GER inducing typical gastro‐intestinal (GI) symptoms. Methods We prospectively enrolled infants and children with GERD‐related respiratory symptoms from January 2015 to December 2015. Age‐ and sex‐matched patients with GERD‐related GI symptoms were enrolled as comparison group. The overall number, the acidity pattern, and the height of reflux episodes were compared between the two groups. Results Forty patients (M/F: 20/20; mean age: 58.3 months) were enrolled in the study group and 40 in the comparison group. The mean acid exposure index was 7.9% within the study group and 15.9% within the comparison group (p:0.026). Children with respiratory symptoms versus children with GI symptoms had a mean of 40.8 acid reflux episodes versus 62.4 (p:0.001), a mean of 2.2 weakly acid reflux episodes versus 20.1 (p:0.002), and a mean of 22.1 weakly alkaline reflux episodes versus 10.2 ( P < 0.001). Separate analysis of both infants and children was performed. Conclusions The main finding of this prospective, controlled study is that children >1 year with GERD‐related respiratory symptoms showed a significantly higher number of weakly alkaline refluxes than children with GERD‐related GI symptoms. This supports the hypothesis that respiratory symptoms are less related to acidity than GI symptoms. Pediatr Pulmonol. 2017;52:669–674. © 2016 Wiley Periodicals, Inc.