Association of Gastro-Esophageal Reflux Disease with Persistent Cough in Infants: Association of Gastro-Esophageal Reflux

Sehar Ansari; Aysha Mansoor Lodhi; Shah Jahan Anwar; Sana Jamil; Bilal Zafar

doi:10.54393/pjhs.v6i7.3192

Authors

Sehar Ansari Department of Pediatrics, University of Child Health Sciences, Lahore, Pakistan
Aysha Mansoor Lodhi Department of Pediatrics, University of Child Health Sciences, Lahore, Pakistan
Shah Jahan Anwar Department of Pediatrics, University of Child Health Sciences, Lahore, Pakistan
Sana Jamil Department of Pediatrics, University of Child Health Sciences, Lahore, Pakistan
Bilal Zafar Department of Pediatrics, University of Child Health Sciences, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i7.3192

Keywords:

Persistent Cough, Gastroesophageal Reflux Disease, Infants, Barium Swallow Test

Abstract

Gastroesophageal reflux disease (GERD) is widely recognized, alongside upper airway cough syndrome (also known as postnasal drip syndrome) and eosinophilic airway inflammation, as one of the predominant causes of chronic cough. Numerous global respiratory societies have published cough management guidelines that advocate for the assessment and treatment of GERD as a fundamental aspect of the diagnostic and therapeutic framework for addressing chronic cough. Objectives: To determine the association of gastroesophageal reflux disease with persistent cough in infants. Methods: This case-control study was conducted in the Department of Paediatric Medicine at The Children's Hospital and The Institute of Child Health, Lahore, from August 25, 2022, to February 25, 2023. This study was conducted on infants with complaints of persistent cough and healthy controls. These two groups underwent baseline assessment carried out by physicians and a diagnosis of GERD was made through a barium swallow test. The data were analyzed through SPSS version 25.0. Odds ratio (OR) was calculated to measure the association between persistent cough and GERD. Results: Among case patients, the mean age was 2.92±2.17 months, and 3.67±2.41 months among control patients. By comparing GERD between case and control groups, it was found that the percentage of GERD was 17.6% in case children and 5.9% control children. The difference was significant (p=0.033) and the risk ratio (OR=3.429). Conclusions: The presence of gastroesophageal reflux disease exhibited a notable correlation with the occurrence of chronic cough in the infant population.

References

Harris J, Chorath K, Balar E, Xu K, Naik A, Moreira A, et al. Clinical Practice Guidelines on Pediatric Gastroesophageal Reflux Disease: A Systematic Quality Appraisal of International Guidelines. Pediatric Gastroenterology, Hepatology and Nutrition. 2022 Mar; 25(2): 109. doi: 10.5223/pghn.2022.25.2.109.

Vergouwe FW, Van Wijk MP, Spaander MC, Bruno MJ, Wijnen RM, Schnater JM, et al. Evaluation of Gastroesophageal Reflux in Children Born with Esophageal Atresia Using pH and Impedance Monitoring. Journal of Pediatric Gastroenterology and Nutrition. 2019 Nov; 69(5): 515–22. doi: 10.1097/MPG.0000000000002468.

Singendonk M, Goudswaard E, Langendam M, Van Wijk M, van Etten‐Jamaludin F, Benninga M, et al. Prevalence of Gastroesophageal Reflux Disease Symptoms in Infants and Children: A Systematic Review. Journal of Pediatric Gastroenterology and Nutrition. 2019 Jun; 68(6): 811–7. doi: 10.1097/MPG.0000000000002280.

Curien-Chotard M and Jantchou P. Natural History of Gastroesophageal Reflux in Infancy: New Data from a Prospective Cohort. BMC Pediatrics. 2020 Apr; 20(1): 152. doi: 10.1186/s12887-020-02047-3.

Tighe MP, Andrews E, Liddicoat I, Afzal NA, Hayen A, Beattie RM. Pharmacological Treatment of Gastro‐Oesophageal Reflux in Children. Cochrane Database of Systematic Reviews. 2023 Aug; (8). doi: 10.1002/14651858.CD008550.pub3.

Rayyan M, Omari T, Naulaers G, Aerts R, Allegaert K, Rommel N. Maturation of Esophageal Motility and Esophagogastric Junction in Preterm Infants. Neonatology. 2020 Dec; 117(4): 495–503. doi: 10.1159/000506481.

Gonzalez Ayerbe JI, Hauser B, Salvatore S, Vandenplas Y. Diagnosis and Management of Gastroesophageal Reflux Disease in Infants and Children: From Guidelines to Clinical Practice. Pediatric Gastroenterology, Hepatology and Nutrition. 2019; 22(2): 107–21. doi: 10.5223/pghn.2019.22.2.107.

Falconer J. Gastro-Oesophageal Reflux and Gastro-Oesophageal Reflux Disease in Infants and Children: Lead Paediatric Dietitian Jackie Falconer Explains the Management of a Condition That Causes Considerable Anxiety to Parents and Can Range from Mild to Severe and Challenging. Journal of Family Health Care. 2010 Oct; 20(5): 175–9.

Takeda N, Takemura M, Hijikata H, Fukumitsu K, Ichikawa H, Asano T, et al. Improvement of Cough Symptom After Treatment of Gastroesophageal Reflux Disease (GERD) Related Cough Association with Sputum Substance P Levels. American Thoracic Society, A101. Advances in Cough, Dyspnea, and Interventional Pulmonary. 2017 May; A2680–A2680.

Ichikawa H, Kanemitsu Y, Takemura M, Takeda N, Fukumitsu K, Asano T, et al. High Prevalence and Impact of Gastroesophageal Reflux Disease in Patients with Subacute/Chronic Cough: A Novel Experience from Japan. American Thoracic Society, A101. Advances in Cough, Dyspnea, and Interventional Pulmonary. 2017 May; A2682–A2682.

Li X, Lin S, Wang Z, Zhang H, Sun X, Li J, et al. Gastroesophageal Reflux Disease and Chronic Cough: A Possible Mechanism Elucidated by Ambulatory pH‐Impedance‐Pressure Monitoring. Neurogastroenterology and Motility. 2019 Dec; 31(12): e13707. doi: 10.1111/nmo.13707.

Chang AB, Oppenheimer JJ, Irwin RS, Adams TM, Altman KW, Azoulay E, et al. Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report. Chest. 2020 Jul; 158(1): 303–29. doi: 10.1016/j.chest.2020.01.042.

Jain A, Patwari AK, Bajaj P, Kashyap R, Anand VK. Association of Gastroesophageal Reflux Disease in Young Children with Persistent Respiratory Symptoms. Journal of Tropical Pediatrics. 2002 Feb; 48(1): 39–42. doi: 10.1093/tropej/48.1.39.

Poddar U. Gastroesophageal Reflux Disease (GERD) in Children. Paediatrics and International Child Health. 2019 Jan; 39(1): 7–12. doi: 10.1080/20469047.2018.1489649.

Mallet MC, Elmiger A, Glick S, Krasnova T, de Jong CC, Kern B, et al. Diagnosis in Children with Prolonged or Recurrent Cough: Findings from the Swiss Paediatric Airway Cohort. Pediatric Pulmonology. 2025 Feb; 60(2): e27499. doi: 10.1002/ppul.27499.

Chen X, Peng WS, Wang L. Etiology Analysis of Nonspecific Chronic Cough in Children 5 Years and Younger. Medicine. 2019 Jan; 98(3): e13910. doi: 10.1097/MD.0000000000013910.

Gan Y, Zhou X, Huang Z, Gao S, Wang G, Gu L, et al. 24 h Combined Esophageal Multichannel Intraluminal Impedance and pH Monitoring in Children with Chronic Cough. BMC Pediatrics. 2024 Aug; 24(1): 538. doi: 10.1186/s12887-024-04975-w.

Saniasiaya J and Kulasegarah J. The Link Between Airway Reflux and Non-Acid Reflux in Children: A Review. Brazilian Journal of Otorhinolaryngology. 2023 May; 89(2): 329–38. doi: 10.1016/j.bjorl.2022.05.002.

Antono B and Dotson A. Gastroesophageal Reflux in Infants and Children: Diagnosis and Treatment. American Family Physician. 2025 Jan; 111(1): 62–72.

Ciciora SL and Woodley FW. Optimizing the Use of Medications and Other Therapies in Infant Gastroesophageal Reflux. Pediatric Drugs. 2018 Dec; 20(6): 523–37. doi: 10.1007/s40272-018-0311-3.