Bronchial hyperreactivity in non‐atopic children with asthma and reflux: Effect of anti‐reflux treatment

Khoshoo, Vikram; Mohnot, Sopan; Haydel, Robert; Saturno, Emilio; Edell, Dean; Kobernick, Aaron K.

doi:10.1002/ppul.21094

Cited by 21 publications

(15 citation statements)

References 21 publications

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“…A systematic review on the prevalence of GERD in children with asthma reported prevalence rates ranging from 19.3% to 65% [109]. These findings were supported in a recent study in 30 children with non-atopic asthma, 21 (70%) of which showed GERD using extended oesophageal pH monitoring [110]. One study compared the prevalence of asthma in 1,980 children .2 yrs of age with GERD to 7,920 controls without GERD.…”

Section: Gastro-oesophageal Refluxsupporting

confidence: 60%

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Comorbidities of asthma during childhood: possibly important, yet poorly studied

Groot

Duiverman²,

Brand³

2010

European Respiratory Journal

104

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Asthma in adults is associated with comorbidities such as obesity, gastrooesophageal reflux, dysfunctional breathing and mental disorders. Herein, we provide an overview of the current state of evidence on these comorbidities in childhood asthma. The prevalence, known mechanisms and possible treatment options for each comorbid condition will be discussed.Obesity is an increasing health problem in children, but its relationship with asthma remains unclear. Allergic rhinitis is a very common comorbidity in asthma, both in children and in adults, but its effect on childhood asthma severity has not been studied. The prevalence and treatment options of dysfunctional breathing, a known comorbidity in adult asthma, have not yet been studied in paediatric asthma. Food allergies appear to cause more severe reactions in patients with asthma. Depressive disorders are more prevalent in childhood asthma than in healthy children, but seem to be poorly recognised and treated in children. Although gastro-oesophageal reflux is commonly thought to be a comorbid disease complicating asthma, it remains uncertain whether treatment improves asthma control.In conclusion, knowledge of asthma comorbidities in childhood is sparse. Further studies are urgently needed to identify the prevalence, and, more importantly, the effects of these comorbidities and their treatment on the degree of asthma control in children.

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Section: Gastro-oesophageal Refluxsupporting

confidence: 60%

“…KHOSHOO et al [110] found a reduction in bronchial hyperreactivity after 2 yrs of GERD treatment in a group of non-atopic asthma patients, but no control group was used. Similarly, in children with asthma and GERD, a modest reduction in nocturnal asthma symptoms was observed during ranitidine treatment [117].…”

Section: Gastro-oesophageal Refluxmentioning

confidence: 99%

Comorbidities of asthma during childhood: possibly important, yet poorly studied

Groot

Duiverman²,

Brand³

2010

European Respiratory Journal

104

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“…In one uncontrolled study of children, 85% with demonstrable GER, lansoprazole improved asthma symptoms in a majority 24 or improved airways reactivity. 25 However, a placebo-controlled trial of omeprazole in 38 children with asthma and GER showed no significant effect of omeprazole on asthma outcomes. 26 These results, in conjunction with ours, indicate that PPI therapy for poorly controlled asthma is not warranted.…”

Section: Discussionmentioning

confidence: 99%

Lansoprazole for Children With Poorly Controlled Asthma: A Randomized Controlled Trial

Holbrook¹,

Wise²,

Gold³

et al. 2012

JAMA: The Journal of the American Medical Association

203

102

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Context Asymptomatic gastroesophageal reflux (GER) is prevalent in children with asthma. It is not known whether treatment of GER with a proton-pump inhibitor (PPI) improves asthma control. Objective To determine whether lansoprazole is effective in reducing asthma symptoms in children without overt GER. Design, Setting, and Patients A multicenter, randomized, masked, placebo controlled, parallel clinical trial comparing lansoprazole to placebo in children with poor asthma control on inhaled corticosteroid treatment conducted at 18 academic clinical centers. Participants were followed for 24 weeks. A subgroup had an esophageal pH study before randomization. Intervention Children received either lansoprazole (15 mg daily < 30 kg; 30 mg ≥ 30 kg) or placebo, 1:1 allocation ratio. Main outcome The primary outcome was the change in Asthma Control score (ACQ, range from 0 to 6). Secondary outcomes included lung function measures, asthma-related quality of life and acute episodes of poor asthma control. Results 306 children were enrolled from April 2011 to August 2010, the median age was 11. The mean change (95% confidence interval (CI)) in the ACQ score was −0.1 (−0.2, 0.1) and −0.2 (−0.4, −0.1) units for the lansoprazole and placebo groups, respectively (P=0.12). There were no detectable treatment differences in secondary outcomes (mean (95% CI) for FEV1(0.00 (−0.08, 0.08)), asthma quality of life (−0.1 (−0.4, 0.1) or episodes of poor asthma control, hazard ratio of 1.18 (95% CI 0.91, 1.53). Among the 115 children with esophageal pH studies, the prevalence of GER was 43%. In the subgroup with a positive pH study, no treatment effect for lansoprazole versus placebo was observed for any asthma outcome. Children treated with lansoprazole reported more upper respiratory infections (63% vs 49%, P=0.02), sore throats (52% vs 39%, P=0.02), and bronchitis (7% vs 2%, P=0.05). Conclusion Among children with poorly controlled asthma without symptoms of GER who were using inhaled corticosteroids, the addition of lansoprazole, as compared to placebo, did not improve symptoms nor lung function but was associated with increased adverse events.

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“…The current patient was likely predisposed to Candida overgrowth by his chronic proton pump inhibitor usage [8]. Clinicians must continue to weigh the increasingly evident risks of chronic acid suppression against its protective effect on esophageal and gastric mucosa [9,10]. In the treatment of gastrocardiac fistulae, empiric coverage for Candida species should be routinely instituted until final cultures become available.…”

Section: Case Reportmentioning

confidence: 95%

Benign post-esophagectomy gastrocardiac fistula

Pentiak

Seder

Chmielewski

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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The development of a gastrocardiac fistula is a rare complication following retrosternal gastric conduit creation. We report a case of a 64-year-old male who presented three years after esophagectomy with massive hematemesis. A fistulous connection between his gastric conduit and right ventricle was identified and successfully treated. Although the patient had an atypical presentation and lacked most of the commonly cited risk factors, the combination of peptic ulcer disease and Candida overgrowth resulted in the formation of a gastrocardiac fistula. Adherence to treatment principles including prompt surgical intervention, adequate coverage of the repair, and antimicrobial therapy against Candida species provides the highest likelihood of success in addressing this potentially lethal disease process.

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Bronchial hyperreactivity in non‐atopic children with asthma and reflux: Effect of anti‐reflux treatment

Abstract: BHR is prevalent in children with asthma and GERD and improves with anti-GERD treatment.

Cited by 21 publications

References 21 publications

Comorbidities of asthma during childhood: possibly important, yet poorly studied

Comorbidities of asthma during childhood: possibly important, yet poorly studied

Lansoprazole for Children With Poorly Controlled Asthma: A Randomized Controlled Trial

Benign post-esophagectomy gastrocardiac fistula

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