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Effect of antireflux treatment on asthma exacerbations in nonatopic children

Vikram Khoshoo1, Robert Haydel

  • 1West Jefferson Medical Center, New Orleans, LA, USA. vkhoshoo@sbcglobal.net

Journal of Pediatric Gastroenterology and Nutrition
|February 28, 2007
PubMed

Insights

Children with asthma and GERD had fewer exacerbations when treated with esomeprazole/metoclopramide or fundoplication compared to ranitidine. Continued PPI/prokinetic treatment is effective for managing pediatric asthma and GERD.

Area of Science:

  • Pediatric Pulmonology
  • Gastroenterology
  • Clinical Therapeutics

Background:

  • Gastroesophageal reflux disease (GERD) is a common comorbidity in children with moderate-persistent asthma.
  • Effective management of GERD may improve asthma control in pediatric patients.
  • Previous treatment with proton pump inhibitors (PPIs) and prokinetics showed clinical improvement in asthma symptoms.

Purpose of the Study:

  • To compare the asthma outcomes of ranitidine versus esomeprazole plus metoclopramide in children with moderate-persistent asthma and GERD.
  • To evaluate the efficacy of continued esomeprazole/metoclopramide treatment or fundoplication as a control in this patient population.

Main Methods:

  • A 6-month follow-up study involving 44 children with moderate-persistent asthma and GERD who previously responded to PPI/prokinetic therapy.
  • Patients were divided into three groups: continued esomeprazole/metoclopramide (Group A, n=30), switched to ranitidine (Group B, n=14), and fundoplication controls (Group C, n=9).
  • Asthma exacerbations were closely monitored, and patients were treated according to a standardized protocol.

Main Results:

  • Group B (ranitidine) experienced significantly more asthma exacerbations per patient (2.2) compared to Group A (esomeprazole/metoclopramide, 0.33) and Group C (fundoplication, 0.77) (P < 0.05).
  • Continued treatment with esomeprazole and metoclopramide demonstrated a favorable asthma outcome.
  • Fundoplication served as an effective control, indicating successful GERD management.

Conclusions:

  • Continued treatment with esomeprazole and metoclopramide is associated with significantly fewer asthma exacerbations in children with moderate-persistent asthma and GERD.
  • Fundoplication also demonstrated a significant reduction in asthma exacerbations, highlighting the importance of GERD control.
  • Ranitidine treatment was less effective in preventing asthma exacerbations compared to esomeprazole/metoclopramide or fundoplication in this cohort.
Abstract

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