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Updated: Jul 18, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Extraesophageal reflux in children
Linda Brodsky1, Michele M Carr
1State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York 14222, USA. lbrodsky@kaleidahealth.org
Insights
Extraesophageal reflux disease (EERD) in children presents variably and requires tailored management. Newer diagnostics and therapies are emerging, but challenges in standardization persist for this distinct condition.
Area of Science:
- Pediatric Gastroenterology
- Otolaryngology
- Digestive Diseases
Background:
- Extraesophageal reflux disease (EERD) is distinct from gastroesophageal reflux disease (GERD), sharing etiology but differing in mucosal damage extent and location.
- EERD in children presents with diverse symptoms and signs, varying by age and disease severity, with long-term effects manifesting early in childhood.
- Emerging understanding includes the roles of pepsin, bile acids, pancreatic enzymes, motility disorders, and food allergies in EERD.
Purpose of the Study:
- To review and synthesize current knowledge on the incidence, diagnosis, management, and long-term consequences of EERD in pediatric populations.
- To contextualize recent advancements in understanding and treating EERD in children.
Main Methods:
- Review of current literature and concepts regarding pediatric EERD.
- Discussion of diagnostic modalities and therapeutic interventions.
Main Results:
- EERD is characterized by varied presentations and lacks a definitive diagnostic test.
- Newer diagnostic tools include multichannel intraluminal pH/impedance, 48-hour Bravo pH monitoring, and hypopharyngeal pH monitoring.
- Proton pump inhibitors offer acid suppression, but treatment variability and alkaline reflux necessitate additional interventions.
Conclusions:
- Pediatric EERD presents heterogeneously, with no universally accepted gold standard diagnostic test.
- Primary management involves lifestyle adjustments, feeding modifications, and medical therapy.
- Standardization of ongoing monitoring for recurrence and therapy duration remains a significant clinical challenge.
Purpose Of Review:
To summarize and contextualize current concepts in the incidence, diagnosis, management and long-term sequelae of extraesophageal reflux disease in children.
Recent Findings:
Extraesophageal reflux disease is a different disease entity from gastroesophageal reflux disease. The two diseases have a common etiology, refluxate causing mucosal damage, but the extent and location of the damage varies considerably depending on the underlying mucosal characteristics. Extraesophageal reflux disease in children is characterized by a broad set of symptoms and signs that vary according to age at presentation and severity of disease. Serious long-term effects begin in childhood. The role of pepsin, bile acids, pancreatic enzymes, motility disorders, and food allergies have only recently been recognized. Newer diagnostic modalities include multichannel intraluminal pH/impedance, the 48 h Bravo implantable probe, and hypopharyngeal pH monitoring. While proton pump inhibitors provide superior acid suppression compared with histamine-2 blockers, variability in response and lack of efficacy for alkaline refluxate often require other therapeutic interventions.
Summary:
Pediatric extraesophageal reflux disease has variable presentation and a gold standard test is still lacking. Primary treatment includes lifestyle and feeding changes and medical therapy. Ongoing monitoring for recurrence and agreement as to duration of therapy present significant challenges not yet standardized amongst practitioners.
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