What is the relationship between pediatric gastroesophageal reflux disease (GERD) and respiratory symptoms?

Updated: Mar 14, 2019
  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD  more...
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Gastroesophageal reflux has been associated with significant respiratory symptoms in infants and children. The infant's proximal airway and esophagus are lined with receptors that are activated by water, acid, or distention. Activation of these receptors can increase airway resistance, leading to the development of reactive airway disease. [5]

In 1892, Osler first postulated a relationship between asthma and gastroesophageal reflux, manifested by a bidirectional cause-and-effect presentation. Accordingly, although gastroesophageal reflux may be involved in the etiology and progression of reactive airway disease, the asthmatic condition (in addition to antiasthmatic medications) may play a role in exacerbation of gastroesophageal reflux.

One postulated mechanism for gastroesophageal reflux–mediated airway disease involves microaspiration of gastric contents that leads to inflammation and bronchospasm. However, experimental evidence also supports the involvement of esophageal acid–induced reflex bronchospasm, in the absence of frank aspiration. In such cases, gastroesophageal reflux therapy using either histamine 2 (H2) blockers or proton pump inhibitors has been shown to benefit patients with steroid-dependent asthma, nocturnal cough, and reflux symptoms. Data from a systematic review of randomized controlled trials do not support the use of proton pump inhibitors to decrease infant crying and irritability. [6, 7]

A study by Lang et al suggested that misattribution of gastroesophageal reflux symptoms to asthma may be a contributing mechanism to excess asthma symptoms in obese children. The study reported that obese children had seven times higher odds of reporting multiple GERD symptoms and that asthma symptoms were closely associated with gastroesophageal reflux symptom scores in obese patients but not in lean patients. [8]

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