Acid Suppression Does Not Change Respiratory Symptoms in Children with Asthma and Gastro-oesophageal Reflux Disease

Overview

Journal Arch Dis Child

Specialty Pediatrics

Date 2005 Aug 23

PMID 16113133

Citations 27

Authors

K Stordal

G B Johannesdottir

B S Bentsen

P K Knudsen

K C L Carlsen

O Closs

M Handeland

H K Holm

L Sandvik

Affiliations

Soon will be listed here.

Abstract

Background: Epidemiological studies have shown an association between gastro-oesophageal reflux disease (GORD) and asthma, and oesophageal acid perfusion may cause bronchial constriction. However, no causative relation has been proven.

Aim: To assess whether acid suppression would lead to reduced asthma symptoms in children with concomitant asthma and GORD.

Methods: Thirty eight children (mean age 10.8 years, range 7.2-16.8; 29 males) with asthma and a reflux index > or =5.0 assessed by 24 hour oesophageal pH monitoring were randomised to 12 weeks of treatment with omeprazole 20 mg daily or placebo. The groups were similar in age, gender, mean reflux index, and asthma severity. Primary endpoints were asthma symptoms (daytime wheeze, symptoms at night, in the morning, and during exercise) and quality of life (PAQLQ). Secondary endpoints were changes in lung function and the use of short acting bronchodilators. At the end of the study a repeated pH study was performed to confirm the efficacy of acid suppression.

Results: The change in total symptom score did not differ significantly between the omeprazole and the placebo group, and decreased by 1.28 (95% CI -0.1 to 2.65) and 1.28 (95% CI -0.72 to 3.27) respectively. The PAQLQ score increased by 0.62 (95% CI 0.29 to 0.95) in the omeprazole group compared to 0.50 (95% CI 0.29 to 0.70) in the placebo group. Change in lung function and use of short acting bronchodilators were similar in the groups. The acid suppression was adequate (reflux index <5.0) under omeprazole treatment.

Conclusion: Omeprazole treatment did not improve asthma symptoms or lung function in children with asthma and GORD.

Citing Articles

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Tighe M, Andrews E, Liddicoat I, Afzal N, Hayen A, Beattie R Cochrane Database Syst Rev. 2023; 8:CD008550.

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Multi-Organ Dysfunction in Cerebral Palsy.

Allen J, Zareen Z, Doyle S, Whitla L, Afzal Z, Stack M Front Pediatr. 2021; 9:668544.

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Randomised trials of proton pump inhibitors for gastro-oesophageal reflux disease in patients with asthma: an updated systematic review and meta-analysis.

Zheng Z, Luo Y, Li J, Gao J BMJ Open. 2021; 11(8):e043860.

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Current therapies for gastro-oesophageal reflux in the setting of chronic lung disease: state of the art review.

McDonnell M, Hunt E, Ward C, Pearson J, OToole D, Laffey J ERJ Open Res. 2021; 6(4).

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References

Kiljander T, Salomaa E, Hietanen E, Terho E . Gastroesophageal reflux in asthmatics: A double-blind, placebo-controlled crossover study with omeprazole. Chest. 1999; 116(5):1257-64. DOI: 10.1378/chest.116.5.1257. View

Levin T, Sperling R, McQuaid K . Omeprazole improves peak expiratory flow rate and quality of life in asthmatics with gastroesophageal reflux. Am J Gastroenterol. 1998; 93(7):1060-3. DOI: 10.1111/j.1572-0241.1998.329_q.x. View

Voutilainen M, Sipponen P, Mecklin J, Juhola M, Farkkila M . Gastroesophageal reflux disease: prevalence, clinical, endoscopic and histopathological findings in 1,128 consecutive patients referred for endoscopy due to dyspeptic and reflux symptoms. Digestion. 2000; 61(1):6-13. DOI: 10.1159/000007730. View

von Mutius E . Presentation of new GINA guidelines for paediatrics. The Global Initiative on Asthma. Clin Exp Allergy. 2000; 30 Suppl 1:6-10. DOI: 10.1046/j.1365-2222.2000.00089.x. View

Harding S, Guzzo M, Richter J . The prevalence of gastroesophageal reflux in asthma patients without reflux symptoms. Am J Respir Crit Care Med. 2000; 162(1):34-9. DOI: 10.1164/ajrccm.162.1.9907072. View

Sacco O, Fregonese B, Silvestri M, Sabatini F, Mattioli G, Rossi G . Bronchoalveolar lavage and esophageal pH monitoring data in children with "difficult to treat" respiratory symptoms. Pediatr Pulmonol. 2000; 30(4):313-9. DOI: 10.1002/1099-0496(200010)30:4<313::aid-ppul7>3.0.co;2-h. View

Vela M, Srinivasan R, Tutuian R, Katz P, Castell D . Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology. 2001; 120(7):1599-606. DOI: 10.1053/gast.2001.24840. View

Jones R, Bytzer P . Review article: acid suppression in the management of gastro-oesophageal reflux disease--an appraisal of treatment options in primary care. Aliment Pharmacol Ther. 2001; 15(6):765-72. DOI: 10.1046/j.1365-2036.2001.00985.x. View

Gislason T, Janson C, Vermeire P, Plaschke P, Bjornsson E, Gislason D . Respiratory symptoms and nocturnal gastroesophageal reflux: a population-based study of young adults in three European countries. Chest. 2002; 121(1):158-63. DOI: 10.1378/chest.121.1.158. View

10.

Kiljander T, Hietanen E, Ovaska J, Helenius H, Liippo K . Gastroesophageal reflux and bronchial responsiveness: correlation and the effect of fundoplication. Respiration. 2002; 69(5):434-9. DOI: 10.1159/000064021. View

11.

Krishnan U, Mitchell J, Messina I, Day A, Bohane T . Assay of tracheal pepsin as a marker of reflux aspiration. J Pediatr Gastroenterol Nutr. 2002; 35(3):303-8. DOI: 10.1097/00005176-200209000-00012. View

12.

Harding S . Acid reflux and asthma. Curr Opin Pulm Med. 2002; 9(1):42-5. DOI: 10.1097/00063198-200301000-00007. View

13.

Gibbons T, Gold B . The use of proton pump inhibitors in children: a comprehensive review. Paediatr Drugs. 2003; 5(1):25-40. DOI: 10.2165/00128072-200305010-00003. View

14.

Khoshoo V, Le T, Haydel Jr R, Landry L, Nelson C . Role of gastroesophageal reflux in older children with persistent asthma. Chest. 2003; 123(4):1008-13. DOI: 10.1378/chest.123.4.1008. View

15.

Tytgat G . Review article: management of mild and severe gastro-oesophageal reflux disease. Aliment Pharmacol Ther. 2003; 17 Suppl 2:52-6. DOI: 10.1046/j.1365-2036.17.s2.5.x. View

16.

Gibson P, Henry R, Coughlan J . Gastro-oesophageal reflux treatment for asthma in adults and children. Cochrane Database Syst Rev. 2003; (2):CD001496. DOI: 10.1002/14651858.CD001496. View

17.

Sontag S, OConnell S, Khandelwal S, Greenlee H, Schnell T, Nemchausky B . Asthmatics with gastroesophageal reflux: long term results of a randomized trial of medical and surgical antireflux therapies. Am J Gastroenterol. 2003; 98(5):987-99. DOI: 10.1111/j.1572-0241.2003.07503.x. View

18.

El-Serag H, Gilger M, Carter J, Genta R, Rabeneck L . Childhood GERD is a risk factor for GERD in adolescents and young adults. Am J Gastroenterol. 2004; 99(5):806-12. DOI: 10.1111/j.1572-0241.2004.30098.x. View

19.

Johnson L, DeMeester T . Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux. Am J Gastroenterol. 1974; 62(4):325-32. View

20.

Davis R, Larsen G, Grunstein M . Respiratory response to intraesophageal acid infusion in asthmatic children during sleep. J Allergy Clin Immunol. 1983; 72(4):393-8. DOI: 10.1016/0091-6749(83)90505-5. View