Chronic Cough and Gastroesophageal Reflux in Children

Abstract

BACKGROUND: Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough? METHODS: We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Delphi methodology was used to obtain consensus. RESULTS: Few randomized controlled trials addressed the first two questions and none addressed the other two. The single meta-analysis (two randomized controlled trials) showed no significant difference between the groups (any intervention for GERD vs placebo for cough resolution; OR, 1.14; 95% CI, 0.45-2.93; P ¼ .78). Proton pump inhibitors (vs placebo) caused increased serious adverse events. Qualitative data from existing CHEST cough systematic reviews were consistent with two international GERD guidelines. CONCLUSIONS: The panelists endorsed that: (1) treatment(s) for GERD should not be used when there are no clinical features of GERD; and (2) pediatric GERD guidelines should be used to guide treatment and investigations.

Microaspiration in GER as one of the causes of bronchial asthma exacerbation and the occurrence of chronic cough in children. History of the problem and diagnostics

“…Частота встречаемости кашля, ассоциированного с гастроэзофагеальным рефлюксом, у детей варьирует от единичных случаев до 10-35% [40]. Таким образом, помимо ЛОР-патологии причиной синдрома «кашля верхних дыхательных путей» может быть и патологический гастроэзофагеальный рефлюкс [41,42,43].…”

Chronic cough in children

“…GOR is commonly reported as a cause of a cough in adult populations. There is a lack of evidence for it as a cause of a chronic cough in otherwise healthy children (Chang et al., 2019), but it may be a cause in adolescents. It is suggested that reflux stimulates a cough by acid causing irritation of the upper respiratory tract, or by aspiration in the lower respiratory tract.…”

“…regurgitation, heartburn or epigastric pain, or neck posturing in infants). GOR treatment may be trialled for 4 to 8 weeks and reassessed, if other causes of cough are excluded (Chang et al., 2019). There is evidence however that overuse of proton pump inhibitors can increase risk of infections, cause vitamin B12 deficiency, and increase fracture risk (Chang et al., 2019).…”

Features of the clinical course of asthma combined with gastroesophageal reflux disease in children

“…Наукові дослідження свідчать про кращу можливість контролю БА в дітей після відповідного лікування ГЕРХ [3,5]. Вчені наго лошують на важливості призначення лікарсь ких препаратів для лікування ГЕРХ у дітей саме за наявності клінічних симптомів цієї патології з метою уникнення серйозних побіч них явищ [1]. Враховуючи вищезазначене, необхідно проводити більш ретельне обстежен ня та лікування дітей з коморбідною БА.…”