Importance of Non-Acid Reflux in Asthma in Children
Condition: Asthma; Gastroesophageal Reflux
MeSH terms: Gastroesophageal Reflux; Asthma
Study type: Observational

Summary: 
      The purpose of the study is to follow the medical course of children with moderate to severe
      asthma and see how this relates to whether they have acid of non-acid gastroesophageal reflux
    

Detailed description: 
      Research Plan

      Hypothesis and Specific Aims:

      Asthma and gastroesophageal reflux are both common medical conditions in infants and children
      as in adults, and often co-exist (Gibson 2002, Andze, 1991). Though an association with overt
      reflux disease and asthma is well described and accepted, occult acid reflux has also been
      shown to be associated with asthma. The vexing question has been whether non-acidic reflux
      exacerbates asthma, particularly moderate to severe asthma. Current approaches and the
      extensive literature to date have dealt with the role of acid reflux only, and hence medical
      management is dominated by gastric acid suppression strategies recently outlined by a
      consensus statement from the North American Society of Pediatric Gastroenterology, Hepatology
      and Nutrition (Rudolph 2001). Based on this consensus, and randomized double blind studies in
      adults, our strategy is to now use long-term proton pump inhibitors. Clinically, this
      intervention has limited impact, and treatment failures are common. Now that non-acid
      gastroesophageal reflux can be measured with the combined impedance and pH probe, the role of
      non acid reflux can finally be evaluated. Our experience thus far confirms findings of
      limited published pediatric studies using a significant role for non-acid reflux in these
      "non -responders", and indeed suggests a greater role of non-acid GER in extra-esophageal
      disorders in general. This new tool supercedes the standard pH probe. Currently the standard
      of care for moderate to severe asthma is evaluation for association with gastroesophageal
      reflux. These cases at NCC-Wilmington undergo 24 hour combined impedance and pH study. With
      the advent of this new tool at NCC-Orlando also, we plan to combine resources at several
      sites to accumulate data on prevalence of acid and non-acid reflux in asthma. This would be
      an effective use of data retrieval attributes of EPIC. Future studies looking at the impact
      of type of refluxate on bronchospasm, parenchymal damage, and even chronic pulmonary
      vascularity changes prospectively would then be set up. Since currently we have no specific
      recommendations for medical treatment of non-acid GER, therapeutic strategies, either with
      existing or newer motility agents, could also be evaluated in the future to develop practice
      guidelines.

      Specific Aim:. What is the prevalence of acid and non-acid GER in moderate to severe asthma
      patients referred for GI evaluation

      Prevalence of acid and non-acid gastroesophageal reflux in children 1 to 18 yrs with moderate
      asthma and severe asthma, referred for evaluation of gastroesophageal reflux at
      NCC-Wilmington, New Jersey, and NCC-Orlando will be obtained. This information will be
      extracted from EPIC templates that have current standards of care incorporated.