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Gastroesophageal reflux and bronchial asthma: prevalence and effect of cisapride therapy
Insights
Gastroesophageal reflux is common in children with uncontrolled asthma. Treating reflux with cisapride improved asthma symptoms and reduced reflux episodes, suggesting a link between reflux and respiratory health.
Area of Science:
- Pediatric Gastroenterology
- Pulmonology
- Clinical Pharmacology
Background:
- Gastroesophageal reflux (GER) is a common condition in children.
- Uncontrolled asthma significantly impacts a child's quality of life.
- The relationship between GER and asthma in pediatric patients requires further investigation.
Purpose of the Study:
- To evaluate the prevalence of GER in children with uncontrolled asthma.
- To assess the efficacy of cisapride treatment on GER and asthma control.
- To explore the correlation between GER and asthma exacerbations.
Main Methods:
- Prolonged esophageal pH monitoring (22-24 hours) was used to diagnose GER in 36 children with uncontrolled asthma.
- Patients received cisapride (0.2 mg/kg q.i.d.) for three months.
- Clinical and pharmacological scores, along with repeat pH monitoring, were used to evaluate treatment outcomes.
Main Results:
- Pathological gastroesophageal reflux was detected in 75% of the children.
- Cisapride treatment led to significant improvement in clinical and pharmacological scores (p < 0.0001).
- Esophageal pH normalized in 81.8% of patients completing follow-up, with a significant decrease in esophageal pH < 4 during sleep (p = 0.002).
Conclusions:
- Gastroesophageal reflux is frequently associated with pediatric uncontrolled asthma.
- Medical therapy targeting GER can improve asthma control and respiratory symptoms.
- Further research is warranted to elucidate the underlying mechanisms connecting GER and asthma.
Abstract:
We evaluated the prevalence of gastroesophageal reflux in 36 children, 22 (61.2%) male and 14 (38.8%) female (median age, 75.5 months; range, 18-178), with noncontrolled asthma by means of prolonged (22-24 h) esophageal pH monitoring. None of the children had gastrointestinal symptoms suggesting gastroesophageal reflux. Atopy was seen in 21 of 36 (58.3%) patients. Pathological gastroesophageal reflux was present in 27 (75%) children. All patients were given cisapride (0.2 mg/kg q.i.d.) for 3 months. A clinical and pharmacological score was determined, and a second pH-metric study was made at the end of the follow-up period. The following pH-metric parameters were evaluated: the total percentage of time pH was < 4, the number of reflux episodes, the number of reflux episodes lasting > 5 min, the length of the longest single reflux episode, and the percentage of time the esophageal pH was < 4 during sleep. The study was completed in 11 of 27 children. The percentage of time that esophageal pH was < 4 improved in nine of 11 (81.8%) patients (p = 0.013). The percentage of time that esophageal pH was < 4 during sleep showed the most significant decrease (p = 0.002) after treatment. Improvement in both clinical and pharmacological scores was highly significant (p < 0.0001) in 19 of 27 patients, eight of whom did not want to repeat the pH study. We conclude therefore that gastroesophageal reflux is frequently associated with noncontrolled asthma and that medical therapy for reflux may improve the further course of respiratory disease.