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Respiratory manifestations of gastro-oesophageal reflux in children
  1. Fernando Maria de Benedictis1,
  2. Andrew Bush2,3
  1. 1Salesi Children's Hospital Foundation, Ancona, Italy
  2. 2Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
  3. 3National Heart and Lung Institute, Imperial School of Medicine, London, UK
  1. Correspondence to Dr Fernando Maria de Benedictis, Salesi Children’s Hospital Foundation 11, via Corridoni, I-60123 Ancona, Italy; pediatria{at}fmdebenedictis.it

Abstract

Gastro-oesophageal reflux disease (GORD) is a complex problem in children. Suspected respiratory manifestations of GORD, such as asthma, chronic cough and laryngitis, are commonly encountered in the paediatric practice, but continue to be entities with more questions than answers. The accuracy of diagnostic tests (ie, pH or pH-impedance monitoring, laryngoscopy, endoscopy) for patients with suspected extraoesophageal manifestations of GORD is suboptimal and therefore whether there is a causal relationship between these conditions remains largely undetermined. An empiric trial of proton pump inhibitors can help individual children with undiagnosed respiratory symptoms and suspicion of GORD, but the response to therapy is unpredictable, and in any case what may be being observed is spontaneous improvement. Furthermore, the safety of these agents has been called into question. Poor response to antireflux therapy is an important trigger to search for non-gastro-oesophageal reflux causes for patients’ symptoms. Evidence for the assessment of children with suspected extraoesophageal manifestations of GORD is scanty and longitudinal studies with long-term follow-up are urgently required.

  • gastroesophageal reflux
  • asthma
  • cough
  • laryngitis
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Footnotes

  • Contributors FMdB wrote the initial draft of the manuscript. Both authors participated in the critical revision for intellectual content and accepted the final version of the manuscript.

  • Funding AB was supported by the NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton and Hare field NHS Foundation Trust and Imperial College, London.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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