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Optimizing the diagnosis of gastroesophageal reflux in children with otolaryngologic symptoms

Simon S Rabinowitz1, Steven Piecuch, Rima Jibaly

  • 1Department of Pediatrics, Long Island College Hospital, Brooklyn, NY 11201, USA. srabinmd@optonline.net

International Journal of Pediatric Otorhinolaryngology
|May 15, 2003
PubMed

Insights

Gastroesophageal reflux (GER) in children with ENT symptoms is often missed by standard pH monitoring. Upper esophageal reflux (UER) testing is crucial for accurate diagnosis and research in these pediatric patients.

Area of Science:

  • Pediatric Gastroenterology
  • Otolaryngology
  • Diagnostic Medicine

Background:

  • Gastroesophageal reflux (GER) is frequently suspected in children with otolaryngologic (ENT) symptoms.
  • Current diagnostic methods for GER in this population, particularly those with isolated ENT issues, require further evaluation.

Purpose of the Study:

  • This study aimed to compare the incidence of pathologic GER in the upper versus lower esophagus in children presenting with ENT symptoms.
  • The goal was to determine the effectiveness of standard GER screening in this specific pediatric cohort.

Main Methods:

  • A retrospective analysis of extended dual-channel intraesophageal pH monitoring was conducted on 28 children (14 infants, 14 older children) with ENT symptoms.
  • Reflux index (RI) was calculated, and upper limits of normal for distal and proximal esophageal RI were established using published data.
  • Upper esophageal reflux (UER) was also assessed in a control group of 27 children without ENT or pulmonary symptoms and with normal lower esophageal reflux (LER) values.

Main Results:

  • Increased esophageal acid exposure, indicative of GER, was found in 29% of infants, 79% of older children, and 54% of the entire cohort with ENT symptoms.
  • Notably, 60% of pediatric patients diagnosed with GER exhibited pH abnormalities confined to the upper esophagus.
  • Mean upper esophageal RIs in the control group aligned with previously published data for infants and adults.

Conclusions:

  • Standard distal pH probe monitoring alone can lead to false-negative results in a significant number of children with ENT symptoms being evaluated for GER.
  • Upper esophageal reflux (UER) testing should be incorporated into clinical practice and research for pediatric patients with ENT symptoms and suspected GER.
  • Accurate diagnosis of GER in children with ENT manifestations necessitates considering reflux beyond the lower esophagus.
Abstract

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