Frequency of gastroesophageal reflux disease in patients with different respiratory tract diseases and its impact on quality of life

FREQUENCY OF GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITHDIFFERENT RESPIRATORY TRACT DISEASES AND ITS IMPACT ON QUALITY OF LIFEÖzge YILMAZGastroesophageal reflux (GER) is spontaneous retrograde movement of gastric contents into theesophagus or oropharynx. This condition that may regress spontaneously during childhood especiallyinfancy, is termed as gastroesophageal reflux disease (GERD) when it leads to pathological findings.GERD can have typical findings associated with gastrointestinal system as well as atypical findings.Atypical findings can be the sole clinical manifestation especially in children who can not express theircomplaints. Coexistence of GERD with many chronic respiratory diseases have been reported many timesbefore. Although the exact direction of the mechanism and pathogenetic relaiionship is not known yet,main mechanisms thought to be involved include reflex bronchospasm, microaspirations and chronicmucosal inflammation.The aim of this study was to evaluate pH monitoring parameters to determine the frequencyof GERD in children without immune deficiency, cystic fibrosis, immotile cilia syndrome,congenital airway abnormalities, organic pathology in upper or lower airways, neurologic,metabolic or gastrointestinal factors, who have respiratory diseases that recur despite conventionaltreatment and to assess quality of life in these children and their mothers.Total of 99 children (58 male, 41 female) aged between 9-180 months were included in thisstudy between March 2005 and March 2006. Children included in the study were grouped into 7according to their diagnosis as wheezy child, recurrent lower respiratory tract infection, nonatopicasthma, atopic asthma, recurrent otolaryngological symptoms, chronic cough, constrictive bronchiolitisobliterans (CBO). Children that fulfilled the criteria to be included in the study underwent 24 hour pHmonitoring. Kindl quality of life and SF 36 questionairres were filled in for all the children and theirfamilies respectively.Frequency of GER in proximal esophagus was not different between the groups. It wasfound to be highest in recurrent otolaryngological symptoms group (86.7%) and lowest in the atopicasthma group (57.1) (p=0.61). Evaluation of GER frequency in distal esophagus revealed thehighest value in the nonatopic asthma group (76.9%). Frequency of distal GER were found to be42.9% in chronic cough group and this was the lowest value among all the groups. However,frequency of distal GER was not significantly different between the groups (p=0.53). Frequency ofGER without discrimination of distal or proximal, was 78.6% in wheezy children group, 82.4% innonatopic asthma group, 76.9% in atopic asthma group, 64.3% in CBO group, 91.7% in recurrentlower respiratory tract infection group, 71.4% in chronic cough group and 93.3 % in recurrentotoparyngologic symptoms group (p=0.47).Evaluation of the KINDL quality of life questionairre results revelaed that total score orsubscores were not significantly different between children with and without GERD. When SF36questionairre was evaluated, it was found that significant difference between the groups with andwithout GERD, was found only in the pain subscore of the mothers (p=0.02). Assessment of theKINDL qulity of life questionairre, that was filled in for all the children included in the study, didnot show a significant difference between the groups. There was no significant difference betweenmothers with and without an asthmatic child according to the results of the SF36 questionairre.Moreover, it was detected that, pain subscore was highest in group 3 and lowest in group 5.In conclusion, frequency of GERD was detected to be high in all chronic upper and lowerrespiratory tract diseases during childhood. Although itdoes not provide exact and epidemiologicalvalue about this issue gives very important information about the frequency of GERD associatedwith general pediatric and respiratory diseases. It was detected that GERD does not have muchimpact on the quality of life in children with chronic respiratory diseases in whom quality of life isthought to be already impaired due to their chronic diseases.