Cough and reflux esophagitis in children: their co-existence and airway cellularity

Data specific for chronic cough (>4-weeks), symptoms of GER and cough severity were collected. Children aged <16-years (n = 150) were defined as 'coughers' (C+) if a history of cough in association with their GER symptoms was elicited before BAL were obtained during elective esophago-gastroscopy. Presence of esophagitis on esophageal biopsies was considered reflux esophagitis positive (E+).C+ (n = 69) were just as likely as C- (n = 81) to have esophagitis, odds ratio 0.87 (95%CI 0.46, 1.7). Median neutrophil percentage in BAL was significantly different between groups; highest in C+E- (7, IQR 28) and lowest in C-E+ (5, IQR 6). BAL positive bacterial culture occurred in 20.7% and were more likely present in current coughers (OR 3.37, 95%CI 1.39, 8.08). Airway neutrophilia (median 20%, IQR 34) was significantly higher in those with BAL positive bacterial cultures than those without (5%, 4; p = 0.0001).In children without lung disease, the common co-existence of cough with symptoms of GER is independent of the occurrence of esophagitis. Airway neutrophilia when present in these children is more likely to be related to airway bacterial infection and not to esophagitis.Adult data suggest that gastroesophageal reflux (GER) disease (GERD) causes 21–41% of chronic cough [1,2]. In adults with chronic cough, a small study (n = 8, median % of neutrophils 6.2) has shown a non significant increase of airway neutrophils when compared to controls (n = 10; median % of neutrophils 3.2) [3]. In children with underlying respiratory problems, chronic cough and airway neutrophilia has been reported to occur with GERD [4]. However, there are no prospective studies that have examined the specific relationship between cough and objectively defined GERD in children without an underlying lung disease, and paediatric cough differs significantly from adult cough [5]. Furthermore, cough may exacerbate GER, these common symptoms may simply co-exists and, cause and effect is far from proven [6,7]