title: A pilot trial on the treatment of gastroesophageal reflux-related cough in infants.
abstract: BACKGROUND
  Diagnosing asthma in infancy is largely made on the basis of the symptoms of cough and wheeze. A similar presentation can be seen in neurologically normal infants with excessive gastroesophageal reflux (GER). There are no randomized placebo controlled studies in infants using proton pump inhibitors (PPI) alone or in addition to prokinetic agents.
  
  
  OBJECTIVE
  The primary objective was to confirm the presence of excessive GER in a population of infants that also had respiratory symptoms suggestive of asthma. Second, in a randomized placebo-controlled fashion, we determined whether treatment of GER with bethanacol and omeprazole could improve these respiratory symptoms.
  
  
  METHODS
  Infants (n=22) with a history of chronic cough and wheeze were enrolled, if they had evidence of GER by history and an abnormal pH probe or gastric emptying scan. Infants were randomly allocated to four treatment groups: placebo/placebo (PP), omeprazole plus bethanacol (OB), omeprazole/placebo (OP), bethanacol/placebo (BP). Evaluations by clinic questionnaire and exam, home diary, and pH probe data were done before, after study-medication and after open label of OB.
  
  
  RESULTS
  Nineteen children were studied. PP did not affect GER or respiratory symptoms, and did not decrease GER measured by pH probe. In contrast, OB decreased GER as measured by pH probe indices and parental assessment. In association, OB significantly decreased daytime coughing and improved respiratory scores. No adverse effects were reported.
  
  
  CONCLUSIONS
  In infants with a clinical presentation suggestive of chronic GER-related cough, the use of omeprazole and bethanacol appears to be viable therapeutic option.
authors.affiliation: 1 Department of Pediatrics, Divisions of Pulmonary, University of Saskatchewan, Canada ; 2 Department of Pediatrics, Divisions of Pulmonary, University of Alberta, Canada ; 3 Department of Pediatrics, Divisions of Gastroenterology, Canada.
authors.forename: Darryl J
authors.initials: DJ
authors.lastname: Adamko
authors.affiliation: 1 Department of Pediatrics, Divisions of Pulmonary, University of Saskatchewan, Canada ; 2 Department of Pediatrics, Divisions of Pulmonary, University of Alberta, Canada ; 3 Department of Pediatrics, Divisions of Gastroenterology, Canada.
authors.forename: Carina M
authors.initials: CM
authors.lastname: Majaesic
authors.affiliation: 1 Department of Pediatrics, Divisions of Pulmonary, University of Saskatchewan, Canada ; 2 Department of Pediatrics, Divisions of Pulmonary, University of Alberta, Canada ; 3 Department of Pediatrics, Divisions of Gastroenterology, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Skappak
authors.affiliation: 1 Department of Pediatrics, Divisions of Pulmonary, University of Saskatchewan, Canada ; 2 Department of Pediatrics, Divisions of Pulmonary, University of Alberta, Canada ; 3 Department of Pediatrics, Divisions of Gastroenterology, Canada.
authors.forename: Adrian B
authors.initials: AB
authors.lastname: Jones
keywords: Cough; esophagus; gastroesophageal reflux; pediatric asthma
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