Gastroesophageal reflux in infants with wheezing

Sheikh, Shahid; Stephen, Thomas; Howell, Laura; Eid, Nemr

doi:10.1002/(sici)1099-0496(199909)28:3<181::aid-ppul4>3.0.co;2-s

Cited by 75 publications

(24 citation statements)

References 24 publications

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“…Although gastro-oesophageal reflux is common among infants and preschool children with chronic or recurrent respiratory symptoms [59], a beneficial effect of demonstrating and treating gastro-oesophageal reflux in infants with wheeze has not been shown.…”

Section: Measurement Of Gastro-oesophageal Refluxmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

Eur Respir J

746

770

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There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis.Based on the limited evidence available, inhaled short-acting b 2 -agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop.Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit.Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

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Section: Measurement Of Gastro-oesophageal Refluxmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

Eur Respir J

746

770

View full text Add to dashboard Cite

show abstract

“…In another study, 64% of infants with wheeze were shown to have GOR, two-thirds of which were able to discontinue inhaled steroid therapy within 3 months of starting anti-reflux therapy [21]. However, in older children, even though there appears to be an association between asthma and GOR [22,23], there is little evidence to suggest that treating GOR results in symptomatic improvement [24,25].…”

Section: Investigations In Preschool Wheezers S Saglani Et Almentioning

confidence: 99%

Investigation of young children with severe recurrent wheeze: any clinical benefit?

Saglani

Nicholson²,

Scallan³

et al. 2006

Eur Respir J

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The management of young children with severe recurrent wheeze is difficult because symptoms are often refractory to conventional asthma therapy and other diagnoses must be excluded. The present authors aimed to evaluate the outcome of detailed, invasive investigations in such patients.Children aged between 3 months and 5 yrs with severe recurrent wheezing, who had been referred to a tertiary centre, underwent a protocol of investigations including a chest computed tomography scan, blood tests, nasal ciliary brushings, fibreoptic bronchoscopy, bronchoalveolar lavage (BAL), endobronchial biopsy and passage of an oesophageal pH probe.A total of 47 children (25 males) with a median age of 26 (range 5-58) months underwent investigation. Of these, 39% were atopic, two-thirds had evidence of gastro-oesophageal reflux and 37 out of 47 had an abnormal bronchoscopy. Findings included structural abnormalities (13 out of 37), excessive mucus (20 out of 37) and macroscopic inflammation (10 out of 37). BAL revealed bacterial growth in 12 out of 44 (27%) patients. Good quality endobronchial biopsies were obtained from 36 out of 46 (78%) patients; of these, 44% had tissue eosinophila and 28% had a thickened reticular basement membrane.Additional investigations (including bronchoscopy) in young children with severe wheeze may help to identify positive diagnoses and provide information to support a clinical diagnosis of asthma. This hypothesis-generating work should form the basis of future interventional studies.

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“…Extraesophageal conditions have been subclassified according to both established and proposed associations; established extraesophageal manifestations of GERD can include respiratory symptoms, including cough and laryngitis, as well as wheezing in infancy. 10,11 Although older studies from the 1990s suggested that GERD may aggravate asthma, recent publications have suggested that the impact of GERD on asthma control is considerably less than previously thought. 10,[12][13][14][15][16][17][18] Other extraesophageal manifestations include dental erosions, and proposed associations include pharyngitis, sinusitis, and recurrent otitis media.…”

Section: Introductionmentioning

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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Gastroesophageal reflux in infants with wheezing

Cited by 75 publications

References 24 publications

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Investigation of young children with severe recurrent wheeze: any clinical benefit?

Gastroesophageal Reflux: Management Guidance for the Pediatrician

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