Asthma and gastroesophageal reflux in children.

Gastroesophageal reflux (GER) is a factor often neglected in the etiopathogenesis of asthma. The estimated incidence of GER in asthmatic children reaches 50-60% and is higher than in the general population. GER may accompany typical symptoms: hoarseness, sore throat, thoracic pain, cough or wheezing. GER may not only aggravate the course of bronchial obstruction, but may also cause it, or trigger obstruction due to other factors. Asthma and GER coincidence has been acknowledged for many years. The paper presents a current review of studies concerning the relations between asthma and GER and attempts to establish, which is the cause and which is the result. The hypotheses how GER can lead to bronchial obstruction, and how obstruction can aggravate GER, are also presented. GER is believed to be a factor causing obstruction by: 1. an indirect mechanism - reflex theory, 2. a direct mechanism - reflux theory, and 3. a neuropeptide-mediated mechanism. The paper also presents diagnostic methods allowing to detect GER in asthmatics. A review of recent studies concerning the treatment of GER in asthmatics, both with pharmacological and surgical methods, is also included. Beneficial effect of antireflux therapy on the course of asthma has been emphasized. Therefore, antireflux therapy is recommended in all patients with concurrent asthma and GER, irrespective of severity of clinical GER symptoms, even in those with silent GER. The essential drugs used in the treatment of GER are proton pump inhibitors. Appropriately high dose level and appropriately long duration of the therapy should be taken into consideration.