An objective study of acid reflux and cough in children using an ambulatory pHmetry-cough logger

Chang, Anne B.; Connor, Frances; Petsky, Helen; Eastburn, M.; Lewindon, Peter; Hall, Charmaine; Wilson, Saul; Katelaris, Peter

doi:10.1136/adc.2009.177733

Cited by 35 publications

(17 citation statements)

References 42 publications

(59 reference statements)

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“…It cannot be overemphasized that pediatric best practice involves both identifying children at risk for complications of GERD and reassuring parents of patients with physiologic GER who are not at risk for complications to avoid unnecessary diagnostic procedures or pharmacologic therapy. [62][63][64] …”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal Reflux: Management Guidance for the Pediatrician

Lightdale¹,

Gremse²,

2013

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Recent comprehensive guidelines developed by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition define the common entities of gastroesophageal reflux (GER) as the physiologic passage of gastric contents into the esophagus and gastroesophageal reflux disease (GERD) as reflux associated with troublesome symptoms or complications. The ability to distinguish between GER and GERD is increasingly important to implement best practices in the management of acid reflux in patients across all pediatric age groups, as children with GERD may benefit from further evaluation and treatment, whereas conservative recommendations are the only indicated therapy in those with uncomplicated physiologic reflux. This clinical report endorses the rigorously developed, well-referenced North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines and likewise emphasizes important concepts for the general pediatrician. A key issue is distinguishing between clinical manifestations of GER and GERD in term infants, children, and adolescents to identify patients who can be managed with conservative treatment by the pediatrician and to refer patients who require consultation with the gastroenterologist. Accordingly, the evidence basis presented by the guidelines for diagnostic approaches as well as treatments is discussed. Lifestyle changes are emphasized as first-line therapy in both GER and GERD, whereas medications are explicitly indicated only for patients with GERD. Surgical therapies are reserved for children with intractable symptoms or who are at risk for life-threatening complications of GERD. Recent black box warnings from the US Food and Drug Administration are discussed, and caution is underlined when using promoters of gastric emptying and motility. Finally, attention is paid to increasing evidence of inappropriate prescriptions for proton pump inhibitors in the pediatric population.

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Section: Discussionmentioning

confidence: 99%

Gastroesophageal Reflux: Management Guidance for the Pediatrician

Lightdale¹,

Gremse²,

2013

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“…Acid reflux in a child with chronic cough does not necessarily mean causality. A recent study showed that nearly 90% of cough spells in children did not correspond with a reflux event documented by pH probe 40. Weakly acid and non-acid reflux has been proposed as causal.…”

Section: Reflux-related Coughmentioning

confidence: 99%

Respiratory manifestations of gastro-oesophageal reflux in children

Benedictis

Bush

2017

Arch Dis Child

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Gastro-oesophageal reflux disease (GORD) is a complex problem in children. Suspected respiratory manifestations of GORD, such as asthma, chronic cough and laryngitis, are commonly encountered in the paediatric practice, but continue to be entities with more questions than answers. The accuracy of diagnostic tests (ie, pH or pH-impedance monitoring, laryngoscopy, endoscopy) for patients with suspected extraoesophageal manifestations of GORD is suboptimal and therefore whether there is a causal relationship between these conditions remains largely undetermined. An empiric trial of proton pump inhibitors can help individual children with undiagnosed respiratory symptoms and suspicion of GORD, but the response to therapy is unpredictable, and in any case what may be being observed is spontaneous improvement. Furthermore, the safety of these agents has been called into question. Poor response to antireflux therapy is an important trigger to search for non-gastro-oesophageal reflux causes for patients' symptoms. Evidence for the assessment of children with suspected extraoesophageal manifestations of GORD is scanty and longitudinal studies with long-term follow-up are urgently required.

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“…Twenty-one of 26 children (75%) with a history of asthma had positive esophageal biopsies. Using a specially designed pH probe, Chang et al [34 ] found that, of 5628 coughs recorded in 20 children over a 24-h period, 83.9% were independent of a reflux event.…”

Section: Laryngopharyngeal Refluxmentioning

confidence: 99%