title: Role of non-acid gastro-esophageal reflux in children with respiratory symptoms.
abstract: Respiratory symptoms are a possible atypical clinical picture of gastro-esophageal reflux disease (GERD). However, a significant number of patients with GERD-related respiratory symptoms do not report improvement despite aggressive acid-suppressive therapy. Some of these refractory cases may be due to the recently appreciated entity of non-acid or weakly acidic reflux. The aim of our study is to assess the pH-impedance features of GER inducing airway symptoms, compared with GER inducing typical gastro-intestinal (GI) symptoms.
  
  
  
  We prospectively enrolled infants and children with GERD-related respiratory symptoms from January 2015 to December 2015. Age- and sex-matched patients with GERD-related GI symptoms were enrolled as comparison group. The overall number, the acidity pattern, and the height of reflux episodes were compared between the two groups.
  
  
  
  Forty patients (M/F: 20/20; mean age: 58.3 months) were enrolled in the study group and 40 in the comparison group. The mean acid exposure index was 7.9% within the study group and 15.9% within the comparison group (p:0.026). Children with respiratory symptoms versus children with GI symptoms had a mean of 40.8 acid reflux episodes versus 62.4 (p:0.001), a mean of 2.2 weakly acid reflux episodes versus 20.1 (p:0.002), and a mean of 22.1 weakly alkaline reflux episodes versus 10.2 (P < 0.001). Separate analysis of both infants and children was performed.
  
  
  
  The main finding of this prospective, controlled study is that children >1 year with GERD-related respiratory symptoms showed a significantly higher number of weakly alkaline refluxes than children with GERD-related GI symptoms. This supports the hypothesis that respiratory symptoms are less related to acidity than GI symptoms. Pediatr Pulmonol. 2017;52:669-674. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Pediatrics, University of Perugia, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Zenzeri
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Quitadamo
authors.affiliation: Department of Pediatrics, University of L'Aquila, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Tambucci
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Ummarino
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Poziello
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Italy.
authors.forename: Erasmo
authors.initials: E
authors.lastname: Miele
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, "Federico II" University of Naples, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Staiano
mesh_terms: D001049:Apnea / Q000150:complications* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000150:complications* / Q000503:physiopathology; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D011014:Pneumonia / Q000150:complications* / Q000503:physiopathology; D011446:Prospective Studies; D012008:Recurrence; D012107:Research Design
keywords: children; pH-impedance monitoring; reflux; respiratory symptoms