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Asthma Differential Diagnosis (demo)Gastro-oesophageal reflux May cause respiratory symptoms and signs The overall effect of GOR in asthmatic children is unclear. Airways obstruction may alter intrathoracic structures and precipitate oesophageal reflux. In some athmatics reflux of acid into just the lower oesophagus may lead to airways obstruction. Some children with significant symptoms of reflux and asthma may be greatly helped by a Nissen’s fundoplication. Indications for investigation may include heart burn, repeated vomiting, severe night time symptoms, or collapse in dependent parts of the lung on Xray. Clinical casespH probe
The best test for acid reflux is pH monitoring. A probe is passed to the lower third of the oesophagus allowing a constant recording of reflux over a 24 hour period. In this case reflux was very severe with a pH of less than four for a considerable time during the night. This particularly severe case was associated with chest X-ray changes and crepitations over the right lung.
Patient
You have seen this patients pH probe above. She has marked inspiratory crepitations and reduced air entry on the right side. An endoscopic Nissen’s fundoplication was performed and her gastrostomy tube and the small scars from her endoscopic surgery are seen. While this case is obvious, difficulty is frequently experienced in evaluating the association of reflux found on pH probe to asthma or other respiratory problems.
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