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Persistent wheezing and gastroesophageal reflux in infants
N S Eid1, R W Shepherd, M A Thomson
1Kosair Children's Hospital, Department of Pediatrics, School of Medicine, University of Louisville, Kentucky.
Insights
Gastroesophageal reflux (GER) is a key factor in persistent infant wheezing. Treating GER, medically or surgically, can significantly improve or resolve wheezing symptoms in infants.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
Background:
- Persistent wheezing in infants often presents a diagnostic challenge.
- Standard asthma treatments may be ineffective in some cases.
Purpose of the Study:
- To evaluate the role of gastroesophageal reflux (GER) in infants with persistent wheezing.
- To assess the efficacy of GER treatment in resolving wheezing symptoms.
Main Methods:
- Study included 12 infants with persistent wheezing unresponsive to conventional therapy.
- Diagnostic methods included cineradiography and 24-hour pH monitoring for GER.
- Treatment involved medical management (prokinetics, H2 antagonists) and surgical intervention (fundoplication) for refractory cases.
Main Results:
- All 12 infants demonstrated GER; 6 achieved complete resolution of wheezing with medical therapy.
- Two patients showed significant improvement requiring intermittent therapy.
- Four patients underwent fundoplication with excellent outcomes, with only one needing further medication.
Conclusions:
- GER should be considered in the evaluation of infants with persistent wheezing.
- Aggressive medical and/or surgical treatment of GER can effectively resolve persistent wheezing in infants.
Abstract:
We have evaluated the presence of gastroesophageal reflux (GER) and the effect of its treatment in 12 infants (mean age, 7 months; range, 4-11 months) with persistent wheezing not responding to bronchodilators and anti-inflammatory asthma medications. All patients had GER on cineradiography and significant acid reflux on 24 hour pH monitoring (percentage of time pH < 4 ranged from 6.1 to 47%). All infants were initially treated with prokinetic agents and with receptor histamine antagonists in addition to aggressive pulmonary therapy. Six patients treated medically had substantially decreased use of asthma medications, completely discontinuing them within 2-4 months. Two patients, though significantly improved, require intermittent asthma therapy. Four patients responding poorly to GER and asthma treatment for 2 months to 2 years had fundoplications. These had an excellent outcome over 1-4.5 years follow-up; only one patient required further asthma medications. Pulmonary function testing was done in six patients before and after 6-8 weeks of therapy indicating significant improvement in peripheral airflow: terminal flow/peak tidal expiratory flow (TEF25/PTEF), and percentage of total expiratory time to reach peak tidal expiratory flow (Tp/Te or Tme/Te). Our experience suggests that evaluation for GER should be considered in infants with persistent wheezing. Aggressive medical and possibly surgical therapy for GER may resolve persistent wheezing.