GERD Associated With Worse Infant Respiratory Disease



ORLANDO – Gastroesophageal reflux disease was associated with prior wheezing and greater severity of infant acute respiratory illness in a study involving 430 term, healthy infants presenting with acute respiratory illness due to bronchiolitis or upper respiratory infection.

New-onset gastroesophageal reflux disease (GERD) during bronchiolitis in previously health infants has been shown to increase the risk for respiratory failure (Acta Paediatr. 2007;96:1025-9). Bronchiolitis is a prominent risk factor for childhood asthma, and GERD is associated with worsened asthma severity (J. Asthma 2011;48:366-73). As yet unknown is whether preexisting GERD (clinically significant reflux) in infants modulates the severity of infant bronchiolitis or the diagnosis of childhood asthma, Dr. Robert S. Valet of Vanderbilt University, Nashville, Tenn., and his associates said in a poster at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.

The 430 infants, aged 0-12 months, were enrolled in the Tennessee Children\'s Respiratory Initiative. The presence of infant GERD was defined by parental report with an answer of "yes" to the question, "Does your child have a history of gastroesophageal reflux disease?"

In all, 45 infants (10%) were reported to have GERD. They were more likely than those without GERD to be white and to have a family history of allergic rhinitis, but did not differ by age at illness, secondhand smoke (SHS) exposure, or family history of asthma. The group with GERD was significantly more likely to have previous treatment for wheeze (42% vs. 25%), and to have bronchiolitis (84% vs. 71%).

The median bronchiolitis severity score (range, 0-12; higher score indicates more severe disease, with a difference of 0.5 being clinically meaningful) in univariate analysis was 5.5 in the GERD group vs. 4.0 in infants without GERD. Adjusting for age, race, sex, and SHS, the increased bronchiolitis severity score in the GERD group persisted (odds ratio, 1.90). Although not significant, 11% of infants with GERD vs. 5% of non-GERD infants needed ICU care, Dr. Valet and his associates reported.

Preexisting GERD was associated with increased bronchiolitis severity and increased recurrent wheezing illness at 2 years, at which time 69% of infants with GERD and 46% of those without GERD had experienced wheeze since initial study enrollment (OR, 2.35; P = .006). And although not statistically significant, 52% with GERD vs. 40% without had used albuterol in this time period (P = .13). However, there was no difference in asthma diagnosis at age 2 years; 24% of infants with GERD were diagnosed with asthma by age 2, compared with 22% of those without GERD (P = .76).

This is the first time that preexisting infant GERD has been associated with increased bronchiolitis severity, Dr. Valet noted. Future study could investigate whether treating infant GERD decreases both bronchiolitis and asthma severity. "These findings should be replicated using a more rigorous assessment of GERD," he concluded.

The study was funded by the Thrasher Research Fund. Dr. Valet said he had no relevant financial disclosures.

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