title: Impact of antisecretory treatment on respiratory symptoms of gastroesophageal reflux disease in children.
abstract: The effect of antisecretory treatment on extraesophageal symptoms of gastroesophageal reflux disease was evaluated. Seventy-eight children presenting with typical and extraesophageal symptoms of gastroesophageal reflux disease underwent a multichannel intraluminal impedance and pH monitoring (MII/pH). Children with a positive MII/pH were randomly treated with proton pump inhibitors (PPIs) or histamine H(2) -receptor antagonists (H(2) RAs) during 3 months. At the end of the treatment period, all patients were recalled. A second treatment period of 3 months was given to those patients who were not symptom-free after 3 months. Thirty-five of the forty-one (85.4%) children with a pathologic MII/pH presented with extraesophageal symptoms and were treated with PPIs (omeprazole; n:19) or H(2) RAs (ranitidine; n:16) for 12 weeks. After 3 months, 11/19 (57.9%) PPI-treated patients had a complete resolution of symptoms; 6/8 nonresponders were treated with PPI for another 3 months and became all symptom-free. The other two underwent a Nissen fundoplication. Only 5/16 (31.2 %) patients treated with H(2) RAs had a complete resolution of symptoms after 3 months; 1/11 was treated again with H(2) RAs during 3 months, and 10/11 were changed to PPIs. In 3/10, a partial resolution of symptoms was achieved, while in 7/10, a complete remission was obtained (P < 0.05). Antisecretory reflux treatment improves extraesophageal reflux symptoms. The efficacy of PPIs is superior to that of H(2) RAs in these children.
authors.affiliation: Department of Pediatrics, University of Naples Federico II, Naples, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Ummarino
authors.forename: E
authors.initials: E
authors.lastname: Miele
authors.forename: P
authors.initials: P
authors.lastname: Masi
authors.forename: A
authors.initials: A
authors.lastname: Tramontano
authors.forename: A
authors.initials: A
authors.lastname: Staiano
authors.forename: Y
authors.initials: Y
authors.lastname: Vandenplas
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D050782:Esophageal pH Monitoring; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D009853:Omeprazole / Q000627:therapeutic use*; D010992:Plethysmography, Impedance; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011899:Ranitidine / Q000627:therapeutic use*; D012140:Respiratory Tract Diseases / Q000188:drug therapy* / Q000209:etiology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D011899:Ranitidine; D009853:Omeprazole