title: The utility of endoscopy and multichannel intraluminal impedance testing in children with cough and wheezing.
abstract: BACKGROUND
  Gastroesophageal reflux (GER) has been implicated as a causal factor in respiratory disease but prior studies have focused on the role of acid alone in the genesis of symptoms. Prior studies have relied on pH probe testing but this is blind to non-acid reflux which has been implicated in the genesis of extraesophageal symptoms. The objective of this prospective, cross-sectional study is to determine the utility of gastroesophageal reflux testing, including multichannel intraluminal impedance with pH (pH-MII) and upper gastrointestinal endoscopy (EGD), in the child with intractable cough and wheezing. We hypothesize that there is a high rate of pathologic reflux testing in these patients.
  
  
  METHODS
  Children ages 1-18 with chronic cough and wheezing who were undergoing bronchoscopy for the evaluation of cough and wheezing were recruited into this prospective, cross-sectional study. They underwent identical reflux testing with pH-MII and EGD at the time of bronchoscopy. Reflux burden, symptom association, and rates of esophageal pathology were determined. Results 58% of patients had abnormal reflux testing; 67% of patients had an abnormal pH-MII test and 32% of patients had abnormal esophageal biopsies. The most common pH-MII abnormality was an abnormal symptom association between cough and reflux and the most common endoscopic abnormality was reflux esophagitis. Seven percent of patients presenting only with cough were diagnosed with eosinophilic esophagitis.
  
  
  CONCLUSIONS
  There is a high yield to reflux testing in children with chronic cough and wheezing.
authors.affiliation: Aerodigestive Disorders Center, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosen
authors.forename: Janine
authors.initials: J
authors.lastname: Amirault
authors.forename: Nikki
authors.initials: N
authors.lastname: Johnston
authors.forename: Kenan
authors.initials: K
authors.lastname: Haver
authors.forename: Umakanth
authors.initials: U
authors.lastname: Khatwa
authors.forename: Eitan
authors.initials: E
authors.lastname: Rubinstein
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis* / Q000209:etiology; D017097:Electric Impedance; D004724:Endoscopy; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000175:diagnosis* / Q000209:etiology
keywords: bronchoalveolar lavage; bronchoscopy; gastroesophageal reflux; non-acid reflux