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11 March 2002

Asthma and gastroesophageal reflux in children.

Ewa Toporowska-Kowalska, Krystyna Wasowska-Królikowska, Aneta Krogulska

Med Sci Monit 2002; 8(3): RA64-71 :: ID: 420895

Abstract

Gastroesophageal reflux (GER) is a factor often neglected in the etiopathogenesisof asthma. The estimated incidence of GER in asthmatic children reaches 50-60% and is higher than inthe general population. GER may accompany typical symptoms: hoarseness, sore throat, thoracic pain, coughor wheezing. GER may not only aggravate the course of bronchial obstruction, but may also cause it, ortrigger obstruction due to other factors. Asthma and GER coincidence has been acknowledged for many years.The paper presents a current review of studies concerning the relations between asthma and GER and attemptsto establish, which is the cause and which is the result. The hypotheses how GER can lead to bronchialobstruction, and how obstruction can aggravate GER, are also presented. GER is believed to be a factorcausing obstruction by: 1. an indirect mechanism - reflex theory, 2. a direct mechanism - reflux theory,and 3. a neuropeptide-mediated mechanism. The paper also presents diagnostic methods allowing to detectGER in asthmatics. A review of recent studies concerning the treatment of GER in asthmatics, both withpharmacological and surgical methods, is also included. Beneficial effect of antireflux therapy on thecourse of asthma has been emphasized. Therefore, antireflux therapy is recommended in all patients withconcurrent asthma and GER, irrespective of severity of clinical GER symptoms, even in those with silentGER. The essential drugs used in the treatment of GER are proton pump inhibitors. Appropriately highdose level and appropriately long duration of the therapy should be taken into consideration.

Keywords: Adolescent, Asthma, Child, Child, Preschool, Diagnosis, Differential, Gastroesophageal Reflux

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