Effect of antireflux treatment on asthma exacerbations in nonatopic children.
OBJECTIVE
To evaluate the asthma outcome of treatment with ranitidine or esomeprazole plus metoclopramide in older children with moderate-persistent asthma and gastroesophageal reflux disease (GERD).


METHODS
The study patients included 44 patients with asthma and GERD who had received 1 year of treatment with a proton pump inhibitor/prokinetic combination and had shown significant clinical improvement in asthma symptoms and no exacerbations for more than 3 months. For further treatment, 30 of the 44 patients continued treatment with esomeprazole/metoclopramide (group A), and 14 switched to ranitidine (group B). Nine patients with GERD and asthma who had previously undergone fundoplication were used as control individuals (group C). All patients were followed up closely for exacerbation of asthma symptoms and treated according to a standardized protocol.


RESULTS
During the 6-month follow-up, group B patients experienced significantly more exacerbations per patient (2.2) than did those in group A (0.33) or group C (0.77) (P < 0.05).


CONCLUSIONS
Fundoplication or continued treatment with esomeprazole and metoclopramide is associated with significantly fewer exacerbations of asthma symptoms in children with moderate-persistent asthma and concomitant GERD in comparison with treatment with ranitidine.
Khoshoo
Vikram
V
West Jefferson Medical Center, New Orleans, LA, USA. vkhoshoo@sbcglobal.net
Haydel
Robert
R
D000293:Adolescent; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D064098:Esomeprazole / Q000627:therapeutic use*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000188:drug therapy* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D011899:Ranitidine / Q000627:therapeutic use*; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D000932:Antiemetics; D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D011899:Ranitidine; D008787:Metoclopramide; D064098:Esomeprazole