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Clinical presentation as a guide to the identification of GERD in children
1Department of Pediatric Otolaryngology, Children's Hospital of Buffalo, 219 Bryant St., Buffalo, NY 14222, USA. mm.carr@utoronto.ca
Insights
Certain airway and feeding symptoms in children may indicate gastroesophageal reflux disease (GERD). Infants under two years old often show airway or feeding issues, while older children may present with airway irritation.
Area of Science:
- Pediatric Gastroenterology
- Otolaryngology
Background:
- Gastroesophageal reflux disease (GERD) is a common condition in children.
- Otolaryngologic symptoms can be challenging to diagnose in pediatric GERD cases.
Purpose of the Study:
- To investigate the correlation between specific otolaryngologic symptoms and the presence of GERD in pediatric patients.
- To identify symptom patterns associated with GERD in children.
Main Methods:
- Retrospective chart review of 295 children with suspected GERD.
- Categorization of symptoms into airway and feeding-related groups.
- Inclusion criteria based on positive diagnostic tests for GERD (barium esophagram, gastric scintiscan, pH probe, biopsy).
Main Results:
- 214 children were diagnosed with GERD.
- Significant symptom differences between GERD-positive and negative groups included stertor, cyanotic spells, frequent emesis, failure to thrive, and choking/gagging.
- Pooled variables (airway flow, airway irritation, feeding) showed significant differences between GERD patients aged ≤2 years and those >2 years.
Conclusions:
- A specific combination of airway or feeding symptoms increases the likelihood of a positive GERD diagnosis in children.
- Younger children (≤2 years) with GERD are more prone to airway or feeding symptoms.
- Older children (>2 years) with GERD are more likely to exhibit airway irritation symptoms.
Objective:
to determine if there is a correlation between common otolaryngologic symptoms and presence of gastroesophageal reflux disease (GERD) in children.
Methods:
charts of 295 children presenting with suspicion of GERD were reviewed for presenting symptoms including: (1) airway symptoms: stertor, stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, blue spells, hoarseness, throat clearing; (2) feeding symptoms: wet burps, globus sensation, frequent emesis, dysphagia, choking/gagging, sore throat, halitosis, food refusal, stomach aches, arching, drooling, chest pain, irritability, and failure to thrive. At least one positive test of barium esophagram, gastric scintiscan, pH probe or esophageal biopsy resulted in inclusion in the GERD positive group.
Results:
214 children had GERD diagnosed while 81 had no positive tests for GERD. Between the GERD positive and GERD negative groups, the significantly different symptoms were stertor (P=0.040), cyanotic spells (P=0.043), frequent emesis (P=0.007), failure to thrive (P=0.006), and choking/gagging (P=0.044). Three pooled variables were created: airway flow (stertor, stridor, cyanotic spells), airway irritation (frequent cough, recurrent croup, throat clearing), and feeding (dysphagia, failure to thrive, frequent emesis). GERD patients who were 2 years or less were compared to those older than 2 years and all three of these pooled variables were significantly different between these groups (P<0. 001).
Conclusion:
children who present with a certain constellation of airway or feeding symptoms are more likely to have a positive GERD test. Children 2 years old or less are more likely to present with airway symptoms or feeding difficulties while children older than 2 years are more likely to present with airway irritation.