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Role of Gastroesophageal Reflux in Children With Unexplained Chronic Cough

Borrelli, Osvaldo*; Marabotto, Caterina; Mancini, Valentina; Aloi, Marina; Macrì, Francesco; Falconieri, Paola; Lindley, Keith J.*; Cucchiara, Salvatore

Journal of Pediatric Gastroenterology & Nutrition: September 2011 - Volume 53 - Issue 3 - p 287–292
doi: 10.1097/MPG.0b013e318216e1ad
Original Articles: Gastroenterology

Objective: The relation between respiratory symptoms and gastroesophageal reflux (GER) is a matter of contention and debate, with limited data in children to substantiate or refute cause and effect. Moreover, there are few data on the relation between nonacid reflux and chronic cough in childhood. We aimed to describe the type and physical characteristics of reflux episodes in children with unexplained chronic cough.

Patients and Methods: Forty-five children with chronic cough underwent 24-hour multichannel intraluminal impedance-pH monitoring (MII-pH monitoring). Symptom association probability (SAP) characterized the reflux-cough association. Twenty children with erosive reflux disease (ERD) served as controls.

Results: Twenty-four children had cough-related reflux (CRR), with 19 having no gastrointestinal symptoms. Twenty-one had cough-unrelated reflux (CUR). CRR and ERD had increased acid (AR), weakly acidic (WAc), and weakly alkaline (WAlk) reflux. Esophageal acid exposure time and acid clearance time were higher in ERD than in CRR and CUR. In the CRR group, of 158 cough episodes related to reflux episodes, 66% involved AR, 18% WAc, and 16% WAlk. Seventeen children had positive SAP, 7 for AR, 5 for both AR and WAc, 4 for both WAc and WAlk, and 1 for WAlk.

Conclusions: In children with unexplained chronic cough, asymptomatic acid and nonacid GER is a potential etiologic factor. The increased acid exposure time and delayed acid clearance characteristic of ERD are absent in cough-related GER. MII-pH monitoring increases the likelihood of demonstrating a temporal association between the cough and all types of reflux.

*Neurogastroenterology and Motility Division, Department of Gastroenterology, Great Ormond Street Hospital for Sick Children and Institute of Child Health, London, UK

Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, “La Sapienza” University of Rome

Division of Respiratory Medicine, Department of Pediatrics, “La Sapienza” University of Rome, Rome, Italy.

Address correspondence and reprint requests to Osvaldo Borrelli, MD, PhD, Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital for Sick Children, Great Ormond Street, WC1N 3HZ London, UK (e-mail:

Received 24 October, 2010

Accepted 22 February, 2011

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN