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Updated: Jun 14, 2026
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Published on: December 14, 2020
Gastroesophageal reflux and asthma in children: a systematic review
Kalpesh Thakkar1, Renu O Boatright, Mark A Gilger
1Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, 6621 Fannin St, CCC 1010, Houston, TX 77030, USA. kthakkar@bcm.tmc.edu
Insights
Gastroesophageal reflux disease (GERD) is associated with childhood asthma, with a higher prevalence in asthma patients than controls. However, more research is needed to clarify this link due to study limitations.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
- Epidemiology
Background:
- The association between gastroesophageal reflux disease (GERD) and asthma in children remains unclear.
- Investigating this relationship is crucial for understanding pediatric respiratory and digestive conditions.
Purpose of the Study:
- To systematically review the literature and examine the association between GERD and asthma in pediatric populations.
- To synthesize existing evidence on the prevalence of GERD in children with asthma and vice versa.
Main Methods:
- Conducted a systematic literature search of PubMed and Embase databases (1966-2008).
- Included full-length English articles with at least 20 pediatric subjects (<18 years).
- Analyzed studies reporting GERD prevalence in asthma patients or asthma prevalence in GERD patients, calculating pooled odds ratios and prevalence estimates.
Main Results:
- Analyzed 20 articles involving 5706 patients; 17 used objective reflux detection methods.
- Found a pooled GERD prevalence of 22.8% (symptoms) and 62.9% (abnormal pH) in children with asthma.
- Studies with controls showed a significantly higher GERD prevalence (22.0%) in asthma cases versus controls (4.8%), with an odds ratio of 5.6.
Conclusions:
- A potential association exists between GERD and asthma in pediatric patients, particularly in referral settings.
- Methodological limitations, lack of population-based and longitudinal studies hinder definitive conclusions.
- Further high-quality research is necessary to elucidate the precise nature of the GERD-asthma connection in children.
Context:
The relationship between gastroesophageal reflux disease (GERD) and asthma in children has been investigated; however, the nature of the association (if any) between these 2 conditions is unclear.
Objective:
We performed a systematic review of the literature to examine the association between GERD and asthma in children.
Methods:
A search of the medical literature was conducted by using PubMed and Embase (1966 through December 2008). Full-length articles in English that described at least 20 subjects younger than 18 years were included if they reported the prevalence of GERD (symptoms, pH studies, endoscopy/histology) in individuals with asthma or the prevalence of asthma in individuals with GERD. We calculated pooled odds ratios from studies that examined control groups, and we pooled prevalence estimates from all studies.
Results:
A total of 20 articles that described 5706 patients fulfilled the inclusion and exclusion criteria. Seventeen studies used objective methods for documenting reflux (eg, pH probe, contrast imaging, impedance, esophagogastroduodenoscopy), 2 studies relied on symptom-based questionnaires, and 1 study used diagnostic codes. Most studies (n = 19) examined the prevalence of GERD in 3726 individuals with asthma and reported highly variable estimates (19.3%-80.0%) and a pooled average of 22.8% with GERD symptoms, 62.9% of 789 patients with abnormal esophageal pH, and 34.8% of 89 patients with esophagitis. Only 5 studies included controls and enrolled 1314 case-patients with asthma and 2434 controls without asthma. The average prevalence of GERD was 22.0% in asthma cases and 4.8% in controls (pooled odds ratio: 5.6 [95% confidence interval: 4.3-6.9]).
Conclusions:
There is a possible association between GERD and asthma in pediatric patients seen with asthma in referral settings. However, because of methodologic limitations of existing studies, the paucity of population-based studies, and a lack of longitudinal studies, several aspects of this association are unclear.
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