Association GERD-Asthma

Gastroesophageal refux disease (GERD) and its treatment with acid-suppressive medications in infancy are possible risk factors for the development of subsequent asthma, but few studies have disentangled the role of GERD with that of its treatment.

 
Objective:

To determine the association of GERD (treated and untreated) in the first year of life, and later asthma.

Design, Setting, and Participants:

Observational retrospective cohort study of children born between 2004-2015. Data were retrived from Italian primary care pediatricians (Pedianet database). All children were followed from birth until ≥3 years.

Exposures:

GERD in the first year of life. Acid-suppressive medications (proton pump inhibitors PPIs and H2 receptor antoagonists H2RAs).

Main Outcome:

Clinically assessed asthma after 3 years (clinical-asthma). Secondary outcomes included asthma identified by anti-asthmatic medications (treated-asthma) and wheezing.

Results:

The cohort was composed of 86,381 children, of which 44,622 male (52%), with median age at the end of follow-up 8 years (4 – 11 years). 1652 children (1.9%) were affected by GERD in the first year of life and 871 (53%) were treated with acid-suppressive medications (781 were untreated). Compared to controls, children with GERD were at increased risk of clinical-asthma (HR: 1.40, 95% CI 1.15–1.70). Risks were similar between treated and untreated GERD (p=0.41). Compared to children without GERD, increased risks of clinical-asthma were observed for treatment with PPIs (HR: 1.18, 95% CI 0.70–2.00) and H2RAs (HR: 1.30, 95% CI 0.96–1.76). Results were similar for treated-asthma, but not for wheezing.

Conclusions and Relevance:

Early-life GERD was associated with later childhood asthma onset. Similar risks in treated and untreated GERD suggest that acid-suppressive medications are unlikely to play a major role in this association.