Correspondence Address:
Mohammed A Youssef
Department of Pediatric Surgery, Alexandria Hospital for Sick Children, Alexandria
Egypt

Full Text

Sir,

Gastroesophageal reflux disease (GERD) is a factor that is often neglected in the etiopathogenesis of asthma. The estimated incidence of GERD in asthmatic children reaches 50-60% and is higher than the incidence of GERD in the general population. [1] Some asthmatic patients present with typical symptoms of GERD, such as heartburn, regurgitation, water brash. Sometimes, reflux-like symptoms like hoarseness, sore throat, thoracic pain, cough or wheezing may precede an episode of asthma. The relationship of GERD and asthma is complex and continues to be debated. Patients with asthma have been shown to have excess acid reflux into the esophagus confirmed by endoscopic evidence of esophagitis in 39% of asthmatics. [2]

Our study included 70 children aged four months to eight years (mean = 34 months) who presented with persistent respiratory symptoms lasting beyond four weeks or had recurrence of these symptoms and were resistant to medical treatment. None of them had any family history of asthma or atopic disease or had parents who smoked. Forty five (64%) of these asthmatic children showed evidence of GERD by endoscopy and pH [3],[4] However, the underlying mechanism for this excess reflux is not known.

The presence of nocturnal symptoms and hoarseness of voice are significant clinical predictors of GER in asthmatic patients. GERD is significantly more common in nonatopic children with asthma-like airway disease compared to the controls and clinical improvement is significant after acid suppressor treatment. Thus, we suggest that children with the diagnosis of nonatopic asthma with recurrent exacerbations despite adequate asthma treatment have a high frequency of GER and that lansoprazole treatment may be considered early in its management. [5]

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