Researchers investigated exercise-induced gastroesophageal reflux in children without asthma.
14 children (5 girls, 9 boys; age range 6-17 years) who complained of respiratory problems during exercise, were enrolled in the study.
All presented with cough and/or dyspnea during an exercise challenge test. However, there was no fall in forced expiratory volume in 1 (FEV1) after exercise, and no fall in SaO2 during exercise.
None of the patients had typical gastroesophageal reflux disease (GERD) symptoms, such as pyrosis and vomiting.
Three patients were already being treated for suspected asthma, with inhaled corticosteroids and beta-agonists or leukotriene receptor antagonists, with no effect.
All 14 patients underwent fiberoptic bronchoscopy with bronchoalveolar lavage (BAL). 24-hour esophageal pH monitoring was also conducted on a separate day. During pH monitoring, the exercise challenge test was repeated, to assess presence of reflux during exercise.
Gastroesophageal reflux was found to correlate with coughing or dyspnea during exercise, in all patients.
|Reflux correlated with coughing and dyspnea during exercise.|
|Allergy and Clinical Immunology International |
There was no significant drop of FEV (more than 10%) after exercise in any of the patients.
The reflux index (RI) and other parameters of pH monitoring were found to be pathological in 13 children.
Irritation of laryngeal mucosa was observed in all subjects, and lipid-laden alveolar macrophages in BAL were found in 64%.
The patients were subsequently started on anti-reflux treatment (cisapride 0.5-1 mh/kg per day) for 6-9 months: 10 children responded well. One month after stopping the treatment, pH monitoring and exercise challenge tests were repeated. No further evidence of GERD was observed.
Jarmila Turzíková, from Prague, Czech Republic, said on behalf of fellow authors, "Esophageal pH monitoring, in combination with exercise challenge test, is recommended as a useful diagnostic method for exercise-induced respiratory symptoms with uncertain etiology.
"In bronchoscopy, evidence of laryngitis posterior and lipid-laden alveolar macrophages in BAL, might be helpful in the diagnosis."