Extraesophageal reflux – otorhinolaryngological complication of gastroesophageal reflux
Authors:
M. Brndiarová 1,3; J. Mikler 1,3; Peter Bánovčin 1,3; T. Michnová 2; J. Fábry 2
Authors‘ workplace:
Klinika detí a dorastu, Jesseniova lekárska fakulta Univerzity Komenského
; Univerzitná nemocnica Martin
prednosta prof. MUDr. P. Bánovčin, CSc.
Klinika respiračných chorôb a detskej tuberkulózy, Jesseniova lekárska fakulta Univerzity
Komenského v Martine, Šrobárov ústav detskej tuberkulózy a respiračných chorôb
1; Dolný Smokovec
poverený riadením MUDr. J. Fábry, PhD.
Centrum experimentálnej a klinickej respirológie, Jesseniova lekárska fakulta Univerzity
2; Komenského, Martin
prednosta prof MUDr. P. Bánovčin, CSc
3
Published in:
Čes-slov Pediat 2011; 66 (2): 85-91.
Category:
Original Papers
Overview
Introduction:
The aim of this prospective study was evaluated the characteristics of extraesophageal reflux (EER) and comparative analysis of parameters of 24 hours intraesophageal pH monitoring in children with gastroesophageal reflux disease (GERD) and EER.
Material and methodes:
Study population was consisted of 119 children (30 with GERD, 30 with positive laryngoscopy for EER, 59 with positive otorinolaryngological disorders without positive laryngoscopy). The median age of the patients was 9 years (quartile 60–12 years). Children were underwent 24 hour intraesophageal pH monitoring with two sensors and flexibile laryngoscopy. We collected information about family, personal, allergic and drugs medical history. The Mann-Whitney U test and χ2 test were used to assess intergroup comparisons.
Results:
Children with gastroesophageal reflux had high prevalence of otorinolaryngological disorders. The typical signs of flexibile laryngoscopy (group II) were laryngitis posterior (43.3%). Male sex was often with EER and GERD. The typical symptomps for children with GERD (group I) in comparative to group II and group III were vomiting (18/2, p<0.001) and abdominal pain (24/9, p<0.001) group II, vomiting (18/6, p<0.001) and abdominal pain (24/23, p=0.001) group III. In 24 hours intraesophageal pH monitoring the nocturnal reflux and reflux in supine possition were typical for group I and daytime reflux and reflux in upright possition were predominantly for group II and III. Duration of the longest reflux was longer in pacients with GERD as patients with EER in distal sensor (group I vs. group II 17/8, p<0.05, group I vs. group II, III 17/8, p<0.05).
Conclusion:
EER is still largely controversial. It is essential to elucidate the molecular basis of pathophysiologic processes with influened the upper esophageal sphincter and the upper airway mucosa and lead to LPR with variation. This could help in discovering of the better diagnostic methods, the treatment and monitoring of EER.
Key words:
extraesophageal reflux, children, 24 hours intraesophageal pH monitoring, gastroesophageal reflux
Sources
1. Fontana GA, Pistolesi M. Cough 3: chronic cough and gastro-oesophageal reflux. Thorax 2003; 58: 1092–1095.
2. Poe RH, Kallay MC. Chronic cough and gastroesophageal reflux disease: experience with specific therapy for diagnosis and treatment. Chest 2003; 123: 679–684.
3. Ay M, Sivasli E, Bayraktaroglu Z, et al. Association of asthma with gastroesophageal reflux disease in children. J Chin Med Assoc 2004; 67: 63–66.
4. De Benedetto M, Monaco G, Marra F. Extra-laryngeal manifestations of gastro-oesophageal reflux. Acta Otorhinolaryngol Ital 2006; 26: 256–259.
5. Koufman JA, Aviv JE, Casiano RR, et al. Laryngopharyngeal reflux: position statement of the Committee on Speech, Voice and Swallowing Disorders of the American Academy of Otolaryngology-Head na d Neck Surgery. Otolaryngol Head Neck Surg 2002; 127: 32–35.
6. Keles B, Oztur K, Gunel E, et al. Pharyngeal reflux in children with chronic otitis media with effusion. Acta Otolaryngol 2004; 124: 1178–1181.
7. Zoumalan R, Madalozzo J, Holinger LD. Etiology of stridor in infants. Ann Otol Rhinol Laryngol 2007; 116: 329–334.
8. Vaezi MF. Laryngeal manifestations of gastroesophageal reflux disease. Curr Gastroenterol Rep 2008; 10: 271–277.
9. Postma GN. Ambulatory pH monitoring methodology. Ann Otol Rhinol Laryngol 2000; 184: 10–14.
10. Axford SE, Sharp N, Ross PE. Cell biology of laryngeal epithelial defenses in health and disease: preliminary studies. Ann Otol Rhinol Laryngol 2001; 110: 10990–1108.
11. Johnston N, Bulmer D, Gilli GA. Cell biology of laryngeal epithelial defenses in health and disease: further studies. Ann Otol Rhinol Laryngol 2003; 112: 481–491.
12. He Z, O’Reilly RC, Bolling L, et al. Detection of gastric pepsin in middle ear fuid of children with otitis media. Otolaryngol Head Neck Surg 2007; 137: 59–64.
13. Ozmen S, Yücel OT, Sinici I, et al. Nasal pepsin assay pH monitoring in chronic rhinosinusitis. Laryngoscope 2008; 118: 890–894.
14. Toros SZ, Toros AB, Ozel L, et al. Investigation of gastric pepsinogen in middle ear fluid of children with glue ear. Acta Otolaryngol 2010; 130: 1220–1224.
15. Cesari U, Galli J, Ricciardiello F, et al. Dysphonia and laryngopharyngeal reflux. Acta Otorhinolaryngol Ital 2004; 24: 13–19.
16. Ahmed TF, Khandwala F, Abelson, TI, et al. Chronic laryngitis associated with gastroesophageal refl ux: prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians. Am J Gastroenterol 2006; 101: 470–478.
17. Barry DW, Vaezi MF. Laryngopharyngeal reflux: More questions than answers. Cleveland Clin J Med 2010; 77: 327–334.
18. Park W, Hicks DM, Khandawala F, et al. Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response. Laryngoscope 2005; 115: 1230–1238.
19. Hassel E. Decisions in diagnosing and managing chronic gastroesophageal reflux disease in children. J Pediatr 2005; 146: 3–12.
20. Koufman JA. The otolaryngologic manifestations of gastroesophageal refux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 1991; 101: 1–78.
21. Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope 2001; 111: 1313–1317.
22. Johnson LF, De Meester TR. Twenty-four-hour pH monitoring of the distal esophagus. J Gastroenterol 1974; 62: 323–332.
23. Richter JE., Bradley LA, De Meester, TR, et al. Normal 24-hr ambulatory esophageal ph values. Influence of study center, pH electrode, age, and gender. Dig Dis Sci 1992; 37: 849–856.
24. Monroy A, Behar P, Brodsky L. Revision adenoidectomy – a retrospective study. Int J Pediatr Otorhinolaryngol 2008; 72: 565–570.
25. Stapleton A, Brodsky L. Extra-esophageal reflux induced adenotonsillar hyperplasia: Case report and literature review. International Journal of Pediatric Otorhinolaryngology 2008; 72: 409–413.
26. Carr MM, Nagy ML, Pizzuto M, et al. Correlation of findings at direct laryngoscopy and bronchoscopy with gastroesophageal reflux disease in children. Arch Otolaryngol Head Neck Surg 2001; 127: 369–374.
27. Ulualp SO, Rodriquez S, Cunningham S, et al. Pharyngeal pH monitoring in infants with laryngitis. Otolaryngol–Head Neck Surgery 2007; 137: 776–779a.
28. Ulualp SO, Rodriquez S, Holmes-Wright AN. Flexible laryngoscopy-guided pharyngeal pH monitoring in infants, Laryngoscope 2007; 117: 577–580b.
29. Semeniouk J, Kaczmarski M. 24 hour esophageal pH monitoring in children with pathological acid gastroesophageal reflux: primary and secondary to food allergy. Part I. Advances in Medical Sciences 2007; 52: 1–7.
30. Nelson SP. Pediatric acid reflux: Diagnosis, associated conditions, and therapy. April 1, NAPNAP Annual Conference 2006: 1–16.
31. Nelson, SP, Chen EH, Syniar GM, et al. Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 2000; 154: 150–154.
32. Noordzij JP, Khidr A, Evans BA, et al. Evaluation of omeprazole in the treatment of refl ux laryngitis: a prospective, placebo-controlled, randomized, double-blind study. Laryngoscope 2001; 111: 2147–2151.
33. Habermann W, Kiesler K, Eherer A, et al. Short-term therapeutic trial of proton pump inhibitors in suspected extraesophageal reflux. J Voice 2002; 16: 425–432.
34. Ulualp SO, Roland PS, Toohill RJ, et al. Prevalence of gastroesophagopharyngeal acid reflux events: an evidence-based systematic review. J Otolaryngol 2005; 26: 239–244.
35. Wang XY, Ye JY, Han DM. Clinical value of 24 hour pH monitoring in patients with laryngopharyngeal reflux disease. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2007; 42: 834–838.
36. Baldi F. Diagnostic strategy in patients with extraesophageal GERD. Curr Gastroenterol Rep 2002; 4: 99–100.
Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2011 Issue 2
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