Pediatric Airway Manifestations of Gastroesophageal Reflux

Abstract

Gastroesophageal reflux (GER) in children may be classified as physiologic or pathologic, depending on its degree and consequences. There are many head and neck complications of GER in pediatric patients, but most numerous are the airway manifestations, including stridor, recurrent croup, exacerbation of subglottic stenosis, laryngeal irritation with or without laryngospasm, chronic cough, and obstructive apnea. Diagnosis may be difficult unless there is a high index of suspicion for GER and awareness of the concept of "silent" GER. We present the common pediatric airway manifestations of GER, illustrated by case reports, and provide a paradigm to assist in the diagnosis and management of children with airway compromise associated with GER.

The role of 24 h pH-recording in pediatric otolaryngologic gastro-esophageal reflux disease

“…Gastro-esophageal reflux disease (GERD) in children has been implicated in various extra-gastro-intestinal (GI) pathologies especially in pulmonary or laryngotracheal diseases such as laryngotracheal stenoses [1], recurrent croup [2] or even otitis media with effusion [3]. The development of 24 h pH monitoring has been one of the most significant advances in the diagnosis of gastro-esophageal refluxs (GER)-related otolaryngologic diseases in children [4].…”

Recurrent respiratory papillomatosis associated with gastroesophageal reflux disease in children

“…Incompetence of the lower esophageal sphincter has been discussed as the most important single factor in GERD. Frequent complications in children are stridor, recurrent croup, exacerbation of subglottic stenosis, laryngeal irritation with or without laryngeal spasm, chronic cough, and obstructive apnea [4]. GERD may especially play an important role in chronic laryngeal diseases or "idiopathic" lesions of the larynx.…”

Silent gastroesophageal reflux disease in patients with pharyngolaryngeal cancer: Further results

“…These otolaryngologic manifestations include: recurrent rhinopharyngitis, otitis media, subglottic stenosis, chronic pharyngitis, posterior laryngitis, and contact ulcers of the larynx. [2][3][4][5][6][7] Some have even hypothesized that GERD is an etiologic factor of pharyngolaryngeal carcinoma. [8][9][10] Koufman, 10 in a review of the literature from 1966 to 1988, cited more than 4000 reports concerning GERD but very few concerning the phenomenon of asymptomatic, or ''silent'' GERD.…”

“…[8][9][10] Koufman, 10 in a review of the literature from 1966 to 1988, cited more than 4000 reports concerning GERD but very few concerning the phenomenon of asymptomatic, or ''silent'' GERD. 2,[11][12][13] We designed a retrospective study to measure the incidence of silent GERD in a group of patients initially seen with pharyngolaryngeal carcinoma. Seventy-two consecutive patients with no GER symptoms underwent 24-hour pH monitoring.…”