Gastroesophageal reflux in infants with wheezing

The relation between silent gastroesophageal reflux (GER) and respiratory p roblems such as persistent wheezing in infants is not well-established. Bet ween January 1994 and June 1997, we evaluated the incidence of GER in 84 ot herwise healthy infants referred to the Pediatric Pulmonary Medicine Divisi on at Kosair Children's Hospital for evaluation of daily wheezing, and we f ollowed their clinical course for 18 months. All underwent 24-hr esophageal pH studies to evaluate GER. The pH probe study was performed at a mean age of 8.74 +/- 4.6 months. Infants with a positive GER study were treated wit h an H-2 receptor antagonist (H(2)RA)and a prokinetic agent for a mean of 5 .6 +/- 2.4 months. At first follow-up visit 3 weeks after esophageal pH stu dies infants treated with an H(2)RA and those who did not have GER but cont inued with daily wheezing were started on flunisolide nasal solution (0.025 %) delivered by nebulizer (125 mcg t.i.d.). Infants in both groups were fol lowed every 1-2 months for a mean of 18 months and ii clinically improved, attempts to decrease their daily asthma medications were made. Fifty-four of 84 (64%) had positive esophageal pH studies (GER-positive gro up), and 24 of them (44%) had no gastrointestinal symptoms suggestive of GE R. Thirty patients had normal esophageal pH studies (GER-negative group). T wenty-two of these 30 (73%) infants without GER required nebulized flunisol ide, compared to 13 of 54 (24%) infants with GER (P < 0.0005). Thirty-five of 54 (64.8%) infants with GER were able to discontinue all daily asthma me dications within 3 months of starting antireflux therapy, while none of the infants without GER were able to discontinue daily asthma medications duri ng the follow-up period (P < 0.0005). We conclude that silent GER is common in infants with daily wheezing, and c ontrolling GER improves morbidity and decreases the need for daily asthma m edications. (C) 1999 Wiley-Liss, Inc.