An accompanying editorial discusses these findings and notes that the supporting evidence for histamine-2 receptor antagonists and proton pump inhibitors in raising gastric pH is robust but the evidence supporting the efficacy for symptom treatment is not. Emerging data suggest that acid reduction carries an increased risk of respiratory and gastrointestinal infections in children, although the current study did not address this quantitatively.
A related paper in JAMA Pediatrics reporting data from a 5-year prospective cohort study of children undergoing bronchoscopy and endoscopy for the evaluation of chronic cough found that acid-suppression therapy clearly alters gastric microflora and this may impact lung microflora through full-column reflux. Future studies need to determine what degree of acid suppression will reduce gastric bacterial growth while still controlling symptoms and whether gastric bacterial growth predicts clinical infection risk. The researchers suggest that these data highlight that any benefit of acid suppression should be weighed against potential risk, particularly in the immunocompromised host.
A NICE guideline on gastro-oesophageal reflux in children and young people is currently in development and expected to be published in January 2015.