Systematic review: the extra-oesophageal symptoms of gastro-oesophageal reflux disease in children

Aliment Pharmacol Ther. 2009 Feb 1;29(3):258-72. doi: 10.1111/j.1365-2036.2008.03879.x.


Background: Extra-oesophageal symptoms are thought to be common, atypical symptoms of gastro-oesophageal reflux disease (GERD) in children.

Aim: To investigate the prevalence of GERD in children with extra-oesophageal symptoms or of extra-oesophageal symptoms in children with GERD, and the effect of GERD therapies on extra-oesophageal symptoms.

Methods: A systematic review of articles in PubMed and EMBASE.

Results: We identified 18 relevant articles. The pooled weighted average prevalence of GERD in asthmatic children was 23%, compared with 4% in healthy controls from the same five studies. The majority of studies evaluating the relationship between apparent life-threatening event (ALTE) and GERD did not suggest a causal relationship. Seven studies reported that respiratory symptoms, sinusitis and dental erosion were significantly more prevalent in children with GERD than in controls. Data from pharmacotherapeutic trials were inconclusive and provided no support for a causal relationship between GERD and extra-oesophageal symptoms.

Conclusions: Possible associations exist between GERD and asthma, pneumonia, bronchiectasis, ALTE, laryngotracheitis, sinusitis and dental erosion, but causality or temporal association were not established. Moreover, the paucity of studies, small sample sizes and varying disease definitions did not allow firm conclusions to be drawn. Most trials of GERD therapies showed no improvement in extra-oesophageal symptoms in children.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Child
  • Child, Preschool
  • Databases as Topic
  • Female
  • Gastric Acid / metabolism*
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / drug therapy
  • Gastrointestinal Agents / therapeutic use*
  • Humans
  • Male
  • Prevalence
  • Respiratory Tract Diseases / drug therapy
  • Respiratory Tract Diseases / etiology*
  • Tooth Erosion / drug therapy
  • Tooth Erosion / etiology*


  • Gastrointestinal Agents