GER and Aspiration in Children

Abstract

Whether gastroesophageal reflux (GER) directly causes lung disease in children is often debated within and among pediatric pulmonologists, gastroenterologists, and otolaryngologists [1, 2]. Respiratory symptoms are quite common in infants and children, and reflux is very common in infants and children. Determining whether respiratory disease and reflux are related or just coexistent processes is an inherently difficult task. Often, there is little or no supporting literature in children to support or refute the implication that GER causes or exacerbates certain lung diseases. Furthermore, while treatment for GER is effective in controlling the symptoms of GER, there are few studies in children that show a significant improvement in lung disease when coexistent GER is treated.

Gastroesophageal reflux is a common occurrence in children and is universally present in newborns and infants. Every infant will have some degree of reflux whether or not they are properly “burped” after a feeding. Gastroesophageal reflux disease (GERD) occurs when reflux has adverse consequences [3]. Therefore, while reflux is common in infants and children, not every child will have significant sequelae consistent with GERD. “Aspiration from above” can be common in certain pediatric patients and refers to the antegrade aspiration of oral contents inadvertently or during the act of swallowing. Given the interplay between the airway and the digestive tract and their close proximity, if antegrade aspiration and/or reflux with aspiration are significant, it can have detrimental effects on the lungs. In infants and children, developmental and anatomic factors can increase the likelihood that reflux and aspiration can be detrimental to the lung.

The aerodigestive tract is much smaller and less developed in infants and children versus that of adults. Because of this, any problems can be magnified and result in failure to thrive and respiratory complications. With respect to reflux, respiratory disease can occur as a consequence of GERD, concurrent with but not due to GERD, or even cause GERD. Determining the clinical significance of reflux and its relationship to lung disease can be of great importance in the evaluation of children with respiratory symptoms. Likewise, determining whether aspiration of oral contents is a contributing factor to lung pathology can have great importance in the treatment of children with lung disease.

This chapter will examine the relationship between aspiration/GERD and lung disease. Specifically, various entities including asthma, bronchiectasis, recurrent pneumonia, bronchiolitis obliterans, upper airway diseases, and apnea will be discussed. We will distinguish GERD with aspiration from “aspiration from above” or antegrade aspiration. We will explore what is known about how reflux and aspiration can have effects upon the lung and what diagnostic evaluations are available for determining whether reflux is leading to aspiration-related lung disease. Finally, we will discuss medical and surgical treatment options that are specific to the child.