Gastro-oesophageal reflux and respiratory disease

Gastro-oesophageal reflux is frequently implicated in pulmonary symptoms, but such a causal connection has not been demonstrated except in a subgroup of the paediatric patients affected. For example, children with mental retardation and pharyngeal dysfunction can develop pulmonary symptoms as a result of aspiration. Even otherwise healthy children can present with hoarseness or other laryngeal complaints as a result of gastro-oesophageal reflux. For the substantial group of children with chronic cough and bronchial asthma, in contrast, a connection with gastro-oesophageal reflux is likely only in isolated cases. In these children it is important to check for concomitant intestinal disorders before further investigations are initiated, which can be stressful for the young patients. The operative approach to the treatment of gastro-oesophageal reflux has lost ground to conservative treatment since the introduction of proton pump inhibitors as the first step in therapy.