Respiratory manifestations of gastro-oesophageal reflux in children

Area of Science:

• Pediatric Gastroenterology
• Pulmonology
• Otolaryngology

Background:

• Gastro-oesophageal reflux disease (GORD) presents complex challenges in pediatric practice.
• Respiratory symptoms like asthma, chronic cough, and laryngitis are frequently suspected to be linked to GORD.
• The exact causal relationship between GORD and these extraesophageal manifestations remains largely undetermined due to diagnostic limitations.

Purpose of the Study:

• To evaluate the diagnostic accuracy of tests for extraesophageal manifestations of GORD in children.
• To assess the efficacy and safety of empiric proton pump inhibitor (PPI) therapy for suspected GORD in pediatric respiratory cases.
• To highlight the need for improved diagnostic strategies and further research in this area.

Main Methods:

• Review of current diagnostic modalities for suspected extraesophageal GORD, including pH monitoring, impedance monitoring, laryngoscopy, and endoscopy.
• Analysis of the utility and limitations of empiric proton pump inhibitor (PPI) trials in children with undiagnosed respiratory symptoms.
• Assessment of existing evidence regarding the management and long-term outcomes of pediatric GORD with respiratory symptoms.

Main Results:

• Diagnostic tests for extraesophageal GORD manifestations show suboptimal accuracy.
• The response to empiric PPI therapy is unpredictable, and spontaneous improvement may be mistaken for treatment efficacy.
• Concerns exist regarding the safety profile of long-term PPI use in children.

Conclusions:

• The diagnostic accuracy for suspected extraesophageal GORD in children is insufficient.
• Empiric antireflux therapy response is unreliable, prompting consideration of alternative diagnoses.
• There is an urgent need for robust longitudinal studies with long-term follow-up to clarify the assessment and management of GORD in pediatric respiratory conditions.