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Gastro-oesophageal reflux and childhood asthma: the acid test
Insights
Gastro-oesophageal reflux was studied in children with asthma. Acid reflux significantly increased airway histamine sensitivity, suggesting it may worsen nocturnal asthma symptoms in some patients.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
- Allergy and Immunology
Background:
- Gastro-oesophageal reflux (GOR) is common in children with asthma.
- The direct impact of GOR on asthma exacerbations, particularly nocturnal symptoms, requires further elucidation.
Purpose of the Study:
- To investigate the presence of GOR in children with moderate to severe asthma.
- To assess the relationship between acid reflux and airway hyperresponsiveness in these patients.
Main Methods:
- Overnight oesophageal pH monitoring was performed in 18 children with asthma.
- A double-blind, placebo-controlled acid challenge test was administered.
- Airway response was measured using peak flow rates and histamine challenge tests.
Main Results:
- Eight out of 18 children showed appreciable gastro-oesophageal reflux during sleep.
- A significant increase in mean histamine sensitivity (p = 0.001) was observed 90 minutes post-acid challenge.
- Five children demonstrated a positive response to the acid drink, indicating reflux may exacerbate their asthma.
Conclusions:
- Gastro-oesophageal reflux is present in a subset of children with moderate to severe asthma.
- Acid reflux can acutely increase airway histamine sensitivity in asthmatic children.
- Reflux associated with a positive acid challenge response likely contributes to nocturnal asthma exacerbations in susceptible individuals.
Abstract:
The presence of gastro-oesophageal reflux was investigated in 18 children with moderate to severe asthma by overnight oesophageal pH monitoring. Appreciable reflux was found during sleep in eight; its relevance to nocturnal asthma was not clear. On another occasion the same children were challenged in a double blind fashion with a drink of dilute hydrochloric acid (0.001 N) and the response of the airways was monitored by peak flow measurements and by histamine challenge tests. There was a significant increase in mean histamine sensitivity (p = 0.001) 90 minutes after the acid drink without any associated change in baseline peak flow rate. Eight children had a significant response to the acid drink, and a further three reacted to a more concentrated solution (0.01 N). In those asthmatic children in whom reflux is associated with a positive response to an acid drink (five out of 18 in the present study) it seems likely that reflux exacerbates nocturnal symptoms.