Chronic Cough and Gastroesophageal Reflux in Children: CHEST Guideline and Expert Panel Report.

Authors:
Anne B Chang
Anne B Chang
Royal Children's Hospital
Australia
John J Oppenheimer
John J Oppenheimer
New Jersey Medical School
Peter J Kahrilas
Peter J Kahrilas
Northwestern University
United States
Dr. Ahmad Kantar, MD, PhD, MSc
Dr. Ahmad Kantar, MD, PhD, MSc
Istituti Ospedalieri Bergamaschi
Head of Pediatric Unit
Pediatrics
Bergamo, Lombardia | Italy
Bruce K Rubin
Bruce K Rubin
Virginia Commonwealth University School of Medicine
Richmond | United States
Miles Weinberger
Miles Weinberger
University of Iowa College of Medicine
United States
Richard S Irwin
Richard S Irwin
University of Massachusetts Medical School
Worcester | United States

Chest 2019 Apr 16. Epub 2019 Apr 16.

Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, UMass Memorial Medical Center, Worcester, MA.

Background: Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough?

Methods: We used the CHEST Expert Cough Panel's protocol and American College of Chest Physicians (CHEST) methodological guidelines and GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. Delphi methodology was used to obtain consensus.

Results: Few randomized controlled trials addressed the first two questions and none addressed the other two. The single meta-analysis (two randomized controlled trials) showed no significant difference between the groups (any intervention for GERD vs placebo for cough resolution; OR, 1.14; 95% CI, 0.45-2.93; P = .78). Proton pump inhibitors (vs placebo) caused increased serious adverse events. Qualitative data from existing CHEST cough systematic reviews were consistent with two international GERD guidelines.

Conclusions: The panelists endorsed that: (1) treatment(s) for GERD should not be used when there are no clinical features of GERD; and (2) pediatric GERD guidelines should be used to guide treatment and investigations.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S00123692193083
Publisher Site
http://dx.doi.org/10.1016/j.chest.2019.03.035DOI Listing
April 2019
9 Reads
7.483 Impact Factor

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