The role of gastroesophageal reflux in asthmatic children. A report on 150 cases.

Aims. - The aim of this study was to evaluate the role of gastroesophageal reflux (GER) in asthmatic children and to determine the occurrence of asthma after anti-reflux treatment. Patients and methods. - In a study group of 518 asthmatic children, 150 cases of asthma and GER were confirmed by radiology or pHmetry. This patient population first received treatment for asthma and then anti-reflux treatment when GER was diagnosed, and was followed up every three months. The improvement in asthmatic symptoms and the effect of anti-reflux treatment in subjects with asthma were examined. Results. - The association of asthma and GER was determined in 29% of the children in this study group. The mean age of the GER subjects was 3.5 years (6.5 years for the entire group, P < 0.05). Asthma was found to be mild in 19 cases, moderate in 83 cases and severe in 48 cases. GER manifestations were respiratory symptoms in 64% of cases and digestive symptoms in 48%. Sixty-six children were treated by inhaled steroids, 27 by cromons, 17 by ketotifen, eight by theophylline and 32 received only symptomatic treatment for acute episodes. After anti-reflux medical therapy, in 122 children (81%) a significant improvement in asthma was observed In 28 cases, no improvement in asthma was found; howe ver, intensified anti-asthma therapy resulted in the improvement of asthma in 24 cases, and in four subjects the asthma became worse. Six children had massive GER even after anti-reflux therapy; only two children underwent surgical anti-reflux treatment (Nissen), with subsequent improvement of asthma in one case. Conclusions. - GER is an asthma-aggravating factor in children. Anti-reflux treatment can improve asthma symptoms. GER may be a consequence of severe asthma, and correct anti-asthma therapy improves both asthma and GER. (C) 2000 Editions scientifiques et medicales Elsevier SAS.