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Cisapride treatment changes the evolution of infant asthma with gastroesophageal reflux
Insights
Gastroesophageal reflux is linked to infant asthma. Treating infants with cisapride significantly reduced asthma symptoms and medication needs, suggesting reflux is a key factor.
Area of Science:
- Pediatrics
- Gastroenterology
- Pulmonology
Background:
- Gastroesophageal reflux (GER) is a potential cause of infant asthma.
- Infant asthma diagnosis and management can be challenging.
Purpose of the Study:
- To investigate the role of GER in infant asthma.
- To evaluate the efficacy of cisapride in managing GER-related infant asthma.
Main Methods:
- A cohort of 34 infants (28 boys, 6 girls) with asthma underwent allergy tests and 24-hour intraesophageal pH monitoring (IEpHM).
- Patients with abnormal IEpHM results were treated with cisapride; others formed the control group.
- Symptom scores, drug consumption, and IEpHM were assessed before and after treatment.
Main Results:
- 65.6% of infants showed abnormal IEpHM, indicating significant GER.
- Cisapride treatment drastically reduced wheezing crisis frequency (4.9 to 0.75) and medication needs (10% required basic treatment).
- Control group also showed symptom improvement, but 44% still needed medication.
Conclusions:
- GER is a common, though not universal, finding in infants with asthma.
- Cisapride treatment effectively reduces wheezing crises and antiasthmatic drug use in infants with GER-associated asthma.
- This study highlights the importance of considering GER in the etiology of infant asthma.
Abstract:
Gastroesophageal reflux has been named as a possible etiologic factor in infant asthma. We studied 28 boys and six girls aged 19.4 +/- 4.8 months whose asthma began at the age of 7.5 months (1 to 28 months). A common protocol including allergy tests and 24-h intraesophageal pH monitoring (IEpHM) was used. Patients with pathologic 24-h IEpHM were treated with cisapride while the rest were considered the control group. Symptoms score and drug consumption were evaluated in both groups, and 24-h IEpHM was repeated at 4 months. IEPHM was pathologic in 65.6% of the infants. In the cisapride group, wheezing crisis frequency decreased from 4.9 +/- 2 to 0.75 +/- 1.2 (p < 0.0002), and only 10% of patients needed basic pharmacologic treatment. The second IEpHM was normal in eight cases, pathologic in six and was not performed in seven. In the controls, wheezing crisis frequency decreased from 4.6 +/- 2.4 to 0.75 +/- 1.8 (p < 0.01), but 44% needed basic pharmacologic treatment (p < 0.05). In conclusion, gastroesophageal reflux is a frequent but not universal finding in infants with asthma; and cisapride treatment spectacularly reduces wheezing crisis frequency and antiasthmatic drug consumption in these patients.