Abstract
The relationship between transhiatal protrusion of gastric mucosa, acid reflux and recurrent bronchitis/pneumonia in children remains unclear.
We conducted a retrospective study involving 51 children (23 F, 29M, mean age 4,8 ± 2,9 y) with recurrent bronchitis/ pneumonia persisting despite correct symptomatic treatment. All children were evaluated between 2008 and 2013 for hiatus hernia by barium study of the upper gastro intestinal tract (BSUGT) and gastro-esophageal reflux by 24 hours pH metry (pHM).
80 % had normal pHM; 74,5% had transhiatal protrusion of gastric mucosa (15 mild, 23 moderate). 11 % had pathological pHM and protrusion; 17 % had no reflux and normal BSUGT. No correlation was found between frequency of bronchitis/pneumonia, acid reflux and transhiatal protrusion. The severity of protrusion was associated with vomiting (r=0,640, p=0,008); there was a trend for an association with wheezing (r=0,310, p=0,07). No correlation was found between the percentage of acid reflux, vomiting, wheezing, nocturnal or dry cough. All children with protrusion were treated with proton-pump inhibitors (PPI), as were the children with reflux. The frequency of bronchitis /pneumonia decreased after onset of treatment, and this benefit persisted after 11,7 ±2,8 months (6,7 ± 5,7/y before, vs 0,8 ±1,2/y after treatment, p<0,001). The severity of protrusion was negatively related to the frequency of bronchitis/pneumonia after treatment(r=-0,487, p=0,002).
We conclude that BSUGT is useful in investigating children with recurrent bronchitis/ pneumonia. The frequency of bronchitis/pneumonia in patients with transhiatal protrusion of gastric mucosa decreased after the onset of PPI, even in case of normal pHM.
- © 2014 ERS