The effect of gastro-esophageal reflux therapy on respiratory diseases in children

In order to examine the effect of reflux therapy on Hyper Reactive Airway Disease (HRAD) and apnea severity, 107 children, 78 with HRAD and 29 with apnea, underwent pH monitoring in the Pediatric Surgery Unit of Wolfson Hospital and the Dana Children's Hospital during the years 1995-1998. Pathological reflux was defined by means of the Boix-Ochoa and RI (Reflux Index) scores. In patients with positive reflux, anti-reflux treatment was initiated. Prior to and following pH monitoring, the respiratory status of all patients (both with and without reflux) was evaluated by a pediatric pulmonologist employing commonly used scores to determine severity. Results: Subject age ranged between one day and 15 years (mean: 15.44 ± 29 months, median: 6.37 months). In HRAD, following anti-reflex treatment the reflux positive group showed a significant score improvement, from an average of 2.9 ± 1.1 units to 1.54 ± 1.2 units (p < 0.0001); a decrease in the number of patients treated with oral corticosteroids (p < 0.01); a close to significant decrease (p = 0.069) in the average dose of inhaled corticosteroids; and a decrease in the number of patients using bronchodilators (p = 0.042). The reflux-negative group, not treated for reflux, displayed no significant improvement, with only a decrease in the severity scores from 2.44 ± 1.0 to 1.78 ± 1.2 units (p = 0.14), and no change on any of the other parameters. In apnea, all patients improved, from an average score of 2.34 ± 0.77 to 0.03 ± 0.19 units (p < 0.0001), with no significant difference between the reflux positive and the reflux negative groups. In view of these findings, it is postulated that anti-reflux therapy may have an additive effect on HRAD severity, beyond that of spontaneous respiratory improvement. We therefore find it appropriate for every severe HRAD patient (frequent exacerbations or high corticosteroid dose) to undergo pH monitoring in order to treat those with proven reflux. In respect to apnea, we cannot attribute any significance to the existence of reflux or to anti-reflux treatment.