Acid Reflux Linked to Chronic Croup

SUNDAY Sept. 21, 2008 -- Children who have continuing recurrence of croup could be suffering from stomach acid reflux problems, University of Utah researchers report.

Croup is typically recognized by a loud cough that often sounds like the barking of a seal. The condition can cause fast or difficult breathing, and sometimes wheezing. Croup has been thought to be caused by a virus, but upper airway problems have also been suggested as a possible trigger.

"We did find a number of children that had congenital narrowing of the upper airway," said study lead researcher Dr. Harlan R Muntz, a professor of pediatric otolaryngology. "In addition, a number of children have findings that appear to indicate that they have gastroesophageal reflux disease."

In gastroesophageal reflux disease, stomach acid causes swelling and inflammation of the larynx, which narrows the airway, Muntz explained. "More importantly, it can trigger more swelling with any kind of viral or respiratory infection," he said.

Muntz thinks that identifying children with gastroesophageal reflux disease could help treat and improve recurring croup. He was expected to present the findings Sept. 21 at the American Academy of Otolaryngology -- Head and Neck Surgery Foundation annual meeting, in Chicago.

For the study, Muntz's team used endoscopy -- a tiny camera attached to a long, thin tube -- to evaluate the airways of 80 children with recurrent croup. The researchers found that 33 percent of the children had narrowing of the airway, and 19 of those children had gastroesophageal reflux disease.

The researchers then treated the children with gastroesophageal reflux disease for one year, and 14 showed improvement in croup, Muntz said.

Muntz said it's unusual for a child to have three or more bouts of croup over a short period of time. "These children need to be evaluated to make sure we know what's happening, and if they have reflux that that's treated to help reduce the frequency and severity of the episodes of croup," he said.

Dr. Dennis Scolnik, a staff physician in the divisions of pediatric emergency medicine and clinical pharmacology & toxicology at the University of Toronto, said he thinks the new study findings may apply to just a small number of croup patients. And, he added, he's concerned that too many children with croup might undergo endoscopy, and cases of asthma could be missed.

"The vast majority of croup is caused by viral infections, and this applies even to recurrent cases," Scolnik said. "This study presents insights into the rare patients with frequently recurrent croup severe and significant enough to warrant endoscopy," he said.

More information

For more on croup, visit the U.S. National Library of Medicine.

Posted: September 2008


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