A Clinical Trial of Proton Pump Inhibitors to Treat Children with Chronic Otitis Media with Effusion

Association Between Dinner-to-Bed Time and Gastroesophageal Reflux-Related Diseases in Children

INTRODUCTION

Gastroesophageal reflux disease (GERD) is characterized by esophageal mucosal injury due to the reflux of gastroduodenal contents. Typical symptoms include heartburn and acid regurgitation. In addition, gastroesophageal reflux (GER) can influence conditions such as otitis media, rhinitis, and asthma. This study aimed to examine the association between dinner-to-bed time and GER-related diseases, such as otitis media, allergic rhinitis, and asthma.

METHODS

This was a longitudinal cohort study using secondary data. Data were collected from a large-scale birth cohort study conducted in Japan including babies born in 2001 and 2010. Dinner-to-bed time was categorized as "longer dinner-to-bed time" (>120 minutes), "shorter dinner-to-bed time" (≤120 minutes or less), and "irregular dinner-to-bed time." Modified Poisson regression with robust variance was used to estimate risk ratios (RRs).

RESULTS

A total of 60,392 children were included in this study. Children with shorter dinner-to-bed time had a higher risk of asthma (adjusted RR (aRR) = 1.10; 95% confidence interval (CI), 1.03-1.18) than those with longer dinner-to-bed time. However, no significant association was observed between shorter dinner-to-bed time and otitis media or allergic rhinitis. Furthermore, supplementary analyses revealed that the risk of asthma was significantly higher in children born in 2001 (aRR = 1.13; 95% CI, 1.04-1.22).

CONCLUSION

This study showed that dinner-to-bed time within 120 minutes after dinner increases the risk of developing asthma. This underscores the importance of considering lifestyle modifications, as certain pediatric asthma cases may be influenced by behaviors that promote GER.

The effects of treating GERD on the outcomes of otitis media with effusion: A systematic review and meta-analysis

OBJECTIVE

Gastroesophageal reflux disease (GERD) may cause otitis media with effusion (OME). However, whether treating GERD can benefit patients with OME has not been well studied.

METHODS

We systematically searched PubMed, Embase, Cochrane Library, and Wanfang databases. The search period was from the establishment of the databases until December 31, 2022. Clinical studies related to GERD treatment on the outcomes of OME were included. Two reviewers independently conducted literature screening and data extraction according to the inclusion and exclusion criteria. To evaluate the quality of the included studies, we used the NOS assessment tool and the RevMan 5.4. Subgroup analysis was conducted to reduce the risk of heterogeneity, and Egger and Begg funnel plots were used to evaluate publication bias. Meta-analysis was performed using Stata14.0 and Review Manager 5.4 software.

RESULTS

Finally, 21,744 patients from 16 studies were included. The results showed that the rate of GERD in OME patients was 0.56 (95 % confidence interval (CI): 0.33, 0.79), while it was 0.04 (95 % CI: 0.03, 0.05) in the adult GERD population. The combined risk ratio (RR) of OME in patients with versus without GERD was 1.58 (95 % CI: 1.35, 1.85; p < 0.01). The efficacy rate of GERD treatment in OME patients was 0.59 (95 % CI: 0.44, 0.74), especially for those with chronic OME (0.64, 95 % CI: 0.36, 0.92). Compared to the control group, treatment with GERD improved the symptoms and efficacy of OME (OR = 1.65; 95 % CI: 0.95, 2.85; p > 0.05). The hearing loss cure rate was 0.70 (95 % CI: 0.57, 0.82).

CONCLUSION

GERD has been suggested to be a high-risk factor for OME. Treatment of GERD can improve the symptoms of OME. However, further studies are required to verify these findings.

Extraesophageal signs of gastroesophageal reflux disease: otorhinolaryngologist’s view

The data on association between various pathologies of the ENT organs and gastroesophageal reflux disease (GERD) is analysed in the article. The variety of extraesophageal signs of GERD in children and adults is given, what is advisable to inform physicians of different specialties about the possibilities of antireflux therapy. These options are expanded with the emergence of a unique new drug, Alfasoxx. Its bioadhesive formula is based on hyaluronic acid and chondroitin sulphate thereby protecting the esophageal mucosa. Alfasoxx acts on the surface of the esophageal mucosa without penetrating into the systemic bloodstream and it also has a low allergenic potential, which has been confirmed by numerous studies. With its healing and repairing effect on erosive lesions of the esophageal epithelium, Alfasoxx in combination with proton pump inhibitors is more effective in achieving regression of clinical manifestations of the disease and improving patients quality of life (according to SF-36 questionnaire) compared to proton pump inhibitors monotherapy.

Outcome of Gastroesophageal Reflux Therapy in Children with Persistent Otitis Media with Effusion

Introduction Otitis media with effusion (OME) is considered one of the most common disorders that affect children during the first years of life. There are many risk factors of persistent middle ear effusion; one of these risk factors is gastroesophageal reflux. Association between persistent OME and gastroesophageal reflux diseases (GERDs) could be explained by respiratory tract infections, insufficient ciliary clearance, and poor drainage of the Eustachian tube.

Objective To investigate whether the control of gastroesophageal reflux plays a role in the management of persistent OME and decreases tympanostomy tube insertion

Method A cross-sectional study was conducted on 50 children complaining of persistent OME. Their ages ranged between 5 and 12 years old. All children were subjected to full history taking, audiological assessment and 24-hour esophageal pH monitoring. The study group was divided according to pH results into two groups: GERD positives and GERD negatives.

Result The prevalence of GERD in persistent OME was 58%. There were statistically significant differences in the hearing levels and middle ear condition before and after the treatment (p < 0.05). The percentage of improvement of children complaining of persistent OME after antireflux treatment was 52%.

Conclusion Gastroesophageal reflux disease should be considered in patients with persistent OME. The administration of proton pump inhibitor (PPI) can set aside superfluous surgical treatment (such as tympanostomy).

Impact of early gastroesophageal reflux disease on childhood otologic outcomes

OBJECTIVE

Recent evidence has suggested that children with gastroesophageal reflux disease (GERD) face increased risk for otologic disease. This study aims to evaluate otologic outcomes in children with GERD using a large pediatric hearing database.

METHODS

Data pertaining to children with GERD in the first year of life were extracted from the Audiological and Genetic Database. Subgroups included children with uncomplicated GERD, complicated GERD (with esophagitis), and GERD requiring surgery (fundoplication or fundoplasty). Main outcome measures included hearing loss (HL) prevalence, type, severity, and progression. Children without GERD in the first year of life served as controls.

RESULTS

5747 children were diagnosed with GERD in the first year of life. Evidence of HL was present in 40.9% children with uncomplicated GERD, 63.1% in children with complicated GERD, 75% in children with GERD requiring surgical intervention, and 43.3% in controls (p < 0.001). Children with GERD requiring surgery demonstrated the highest odds of developing any HL (aOR 3.02 [1.40-7.26]), moderate-to-profound HL (aOR 3.44 [1.56-7.29]), and mixed HL (aOR 4.58 [2.07-9.65]) relative to children with uncomplicated or complicated GERD. GERD requiring surgery was independently associated with Eustachian tube dysfunction (aOR 2.41 [1.17-5.20]) and tympanostomy tube placement (aOR 6.23 [3.05-13.01]).

CONCLUSION

GERD diagnosed within the first year of life is associated with pediatric hearing impairment and otologic issues, including otitis media, Eustachian tube dysfunction, and need for tympanostomy tube placement. GERD requiring surgical intervention is particularly associated with hearing loss in this population. Children with GERD and HL deserve close audiologic follow-up.