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Journal of Indian Association of Pediatric Surgeons, Vol. 12, No. 2, April-June, 2007, pp. 105-106 Letter To Editor Gastroesophageal reflux disease and bronchial asthma in children: A surgical point of view Youssef MohammedA, Sedky Hany, El-Gohary MohammedA Department of Pediatric Surgery, Alexandria Hospital for Sick Children, Alexandria Code Number: ip07039 Sir, Gastroesophageal reflux disease (GERD) is a factor that is often neglected in the etiopathogenesis of asthma. The estimated incidence of GERD in asthmatic children reaches 50-60% and is higher than the incidence of GERD in the general population. [1] Some asthmatic patients present with typical symptoms of GERD, such as heartburn, regurgitation, water brash. Sometimes, reflux-like symptoms like hoarseness, sore throat, thoracic pain, cough or wheezing may precede an episode of asthma. The relationship of GERD and asthma is complex and continues to be debated. Patients with asthma have been shown to have excess acid reflux into the esophagus confirmed by endoscopic evidence of esophagitis in 39% of asthmatics. [2] Our study included 70 children aged four months to eight years (mean = 34 months) who presented with persistent respiratory symptoms lasting beyond four weeks or had recurrence of these symptoms and were resistant to medical treatment. None of them had any family history of asthma or atopic disease or had parents who smoked. Forty five (64%) of these asthmatic children showed evidence of GERD by endoscopy and pH < 4 in the distal esophagus. The children with reflux were divided into two groups: Group (A) included 35 who were put on a medical treatment regimen (lifestyle adjustment, prokinetics and proton pump inhibitors) and ten patients in Group (B) who were subjected to open Nissen's fundoplication. Twenty five children with no evidence of reflux were put on medical treatment for GERD and were labeled as group (C). Patients were followed up for six months with dose adjustment of the medical treatment every two weeks. There was a significant reduction in the number of days when bronchodilators were needed in the first six months of follow-up in groups (A) and (B) following medical or surgical treatment of GERD, In group (A), 67% of the patients did not require the use of bronchodilators compared to 75% of group (B). Patients in group (C) did not show any significant changes in their symptoms. Whether GERD causes asthma or is a significant cofactor in the pathogenesis of asthma continues to be debated. Patients with asthma have been shown to have excess acid reflux into the esophagus. [3],[4] However, the underlying mechanism for this excess reflux is not known. The presence of nocturnal symptoms and hoarseness of voice are significant clinical predictors of GER in asthmatic patients. GERD is significantly more common in nonatopic children with asthma-like airway disease compared to the controls and clinical improvement is significant after acid suppressor treatment. Thus, we suggest that children with the diagnosis of nonatopic asthma with recurrent exacerbations despite adequate asthma treatment have a high frequency of GER and that lansoprazole treatment may be considered early in its management. [5] References
Copyright 2007 - Journal of Indian Association of Pediatric Surgeons |
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