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Bronchial asthma and acid reflux into the distal and proximal oesophagus
P M Gustafsson1, N I Kjellman, L Tibbling
1Department of Paediatrics, University Hospital, Linköping, Sweden.
Insights
Pathological gastro-oesophageal reflux is common in pediatric asthma patients, affecting 50%. However, reflux only triggered asthma symptoms in a few, suggesting other factors are more significant for asthma exacerbations.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
- Clinical Medicine
Background:
- Asthma is a common respiratory condition in children and adolescents.
- Gastro-oesophageal reflux disease (GERD) is a potential trigger for asthma exacerbations.
- The relationship between reflux and asthma symptoms in pediatric populations requires further investigation.
Purpose of the Study:
- To determine the prevalence of pathological gastro-oesophageal reflux in children and adolescents with asthma.
- To assess the role of oesophagobronchial nerve reflexes and gastric acid aspiration in triggering asthma attacks.
- To investigate the correlation between reflux episodes and asthma symptom onset.
Main Methods:
- A cohort of 42 children and adolescents (aged 9-20 years) with moderate to severe asthma participated.
- 24-hour two-level esophageal pH monitoring was employed to assess gastro-oesophageal reflux.
- Correlation analysis was performed between reflux episodes and asthma symptom occurrences.
Main Results:
- 50% of subjects exhibited pathological total reflux time in the distal esophagus.
- 16% showed pathological reflux in the proximal esophagus.
- Asthma symptoms were significantly correlated with preceding distal esophageal reflux in 3 patients and proximal reflux in 1 patient.
Conclusions:
- Pathological gastro-oesophageal reflux is prevalent in pediatric asthma patients.
- While common, reflux appears to provoke asthma symptoms in a minority of affected children.
- Distal esophageal acid exposure, potentially via vagal reflexes, more frequently elicited asthma symptoms than aspiration.
Abstract:
The prevalence of pathological gastro-oesophageal reflux in children and adolescents with asthma was studied by 24 hour two level oesophageal pH monitoring in 42 subjects aged 9-20 years with moderate or severe bronchial asthma. The importance of oesophagobronchial nerve reflexes and of aspiration of gastric acid as triggers in asthma was assessed by studying whether episodes of reflux into the distal and into the proximal oesophagus were followed by asthma attacks. Twenty-one subjects (50%) had a pathological total reflux time in the distal oesophagus and six (16%) in the proximal oesophagus. Nine patients had pathological gastro-oesophageal reflux into the distal oesophagus together with symptoms of asthma during the day on which the recording took place. In three of them the episodes of asthma symptoms were significantly correlated with preceding episodes of reflux into the distal oesophagus, and in one subject to reflux into the proximal oesophagus. We conclude that pathological gastro-oesophageal reflux is common in children and adolescents with asthma, but it seems to provoke symptoms of asthma in only a few. Symptoms of asthma were more often elicited by exposure of the distal oesophagus to gastric acid, possibly by a vagal reflex, than by aspiration of gastric juice.