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Gastroesophageal reflux: A critical factor in pediatric subglottic stenosis
1Department of Otolaryngology, Medical University of South Carolina, Charleston 29425, USA.
Insights
Aggressive antireflux therapy significantly improves outcomes for children with subglottic stenosis (SGS). Many children with SGS become asymptomatic with treatment alone, and surgical repair success rates increase.
Area of Science:
- Pediatric Otolaryngology
- Gastroenterology
- Pulmonology
Background:
- Gastroesophageal reflux (GER) is a known cause of pediatric subglottic stenosis (SGS).
- Effective management of GER is crucial for improving clinical outcomes in children with SGS.
Purpose of the Study:
- To evaluate the impact of aggressive antireflux therapy on clinical outcomes in children with SGS.
- To compare outcomes before and after the implementation of a standardized aggressive antireflux protocol.
Main Methods:
- Retrospective analysis of 35 children with SGS treated with aggressive antireflux therapy (omeprazole and cisapride).
- Comparison of outcomes with historical data from children treated perioperatively for reflux before 1994.
- Utilized double pH probe testing to monitor GER and response to medication.
Main Results:
- Nine of 25 children (36%) achieved symptom resolution with aggressive antireflux therapy alone.
- Endoscopic surgical repair was successful in 15 of 16 patients (94%) following aggressive therapy.
- In a historical cohort, 10 of 57 children (17.5%) required tracheotomy after endoscopic repair without aggressive pre-treatment.
- Five of these 10 patients (50%) were decannulated after subsequent aggressive antireflux therapy.
Conclusions:
- Aggressive antireflux therapy, including omeprazole and cisapride, significantly improves outcomes for children with subglottic stenosis.
- A substantial portion of children with SGS can be managed non-surgically with effective GER treatment.
- GER in infants with SGS may be persistent and not outgrown with age, necessitating long-term management.
Abstract:
Gastroesophageal reflux (GER) plays a causative role in the development of subglottic stenosis (SGS) in children. This study examined the impact of aggressive antireflux therapy on the clinical outcomes of 35 children. Since 1994, 25 children were treated aggressively with omeprazole and cisapride before endoscopic surgical repair of their stenoses, which ranged from Cotton grades 1 to 3. Nine patients became asymptomatic on antireflux therapy alone. Endoscopic repair was performed in 16 patients. Endoscopic repair failed in only 1, who required tracheotomy. Before 1994, all children undergoing endoscopic repair of SGS were treated perioperatively for reflux. Endoscopic repair failed in 10 of the 57 children, and all required tracheotomy. The clinical outcome of these 10 patients after aggressive antireflux therapy is described. Five of the 10 have been decannulated. The role of double pH probe testing and the importance of the pharyngeal probe for monitoring the response to antireflux medication are described. The probe data suggest that in some instances GER may be limited to perioperative stress, but in many cases, especially in premature infants with SGS, GER can persist unabated for years and is not outgrown as the patient matures.