Gastro-esophageal reflux-associated cough in children (reflux cough): up-to-date review

Öner Özdemir

Abstract

Chronic unexplained cough, defined as coughing for more than four weeks, is a frequent childhood symptom. Pediatric normal cough is a common complaint in 35% of preschool children and in 9% of 7-11-year-olds. Nevertheless, chronic non-specific cough has been reported to be associated with a variety of illnesses, including asthma, gastro-esophageal reflux (GER), post-nasal drip syndrome (PNDS), post-viral illness, and passive smoking. PNDS, asthma and GER account for > 90% of the likely etiologic factors of chronic cough in children and respond to appropriate treatment. Accordingly, GER is one of the three most common causes of chronic cough in all age groups. GER is known as a frequent and benign affection, especially during infancy. However, cough and GER are common ailments and their co-existence by chance is high. Cough also can induce reflux episodes. GER most likely causes chronic cough by stimulation of an esophageo- tracheo-bronchial reflex. Diagnosing GER-related cough is challenging since many patients do not have esophagitis or an increased esophageal acid exposure during 24-hour esophageal pHmetry. In interpreting this test, it is essential not only to evaluate the duration and frequency of the reflux episodes but also to determine the temporal relationship between reflux and cough events. In treating patients with chronic cough resulting from GER, cough has been reported to resolve with medical therapy 70-100% of the time. Treatment for GER includes conservative measures (diet and postural manipulation), pharmaceutical therapy such as prokinetic agents, H2-antagonists and proton pump inhibitors. If maximal medical therapy fails, anti-reflux surgery (fundoplication) can be successful.

Keywords

Chronic cough, proton pump inhibitors, esophagitis, gastroesophageal reflux
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