Esophageal pathology and the aerodigestive triple endoscopy for pediatric recurrent croup

Recurrent croup (RC) is characterized by recurrent episodes of stridor, barking cough, and hoarseness. While viral infections are the primary cause in croup, RC is thought to be caused by non-infectious etiologies such as structural airway abnormalities, allergic disorders, airway hyperresponsiveness and gastroesophageal reflux (GERD). Recent studies have suggested a potential link between esophageal diseases, particularly GERD/reflux esophagitis and eosinophilic esophagitis (EoE), and RC. This retrospective study aims to explore the association between esophageal disorders and RC through a multidisciplinary approach. A total of 68 patients with RC were identified in our aerodigestive center, 47 of whom underwent dual or triple endoscopy. Of these, 17 patients (36 %) were found to have esophageal disease, including EoE (15 %) and reflux esophagitis (19 %). Notably, food allergies were significantly more prevalent in the EoE group, and all patients with EoE had reported GI symptoms previously. While airway abnormalities were common across all groups, there were no significant differences between patients with and without esophageal disease. The study highlights the prevalence of esophageal diseases in patients with RC, particularly EoE, and a multidisciplinary aerodigestive evaluation may be beneficial for diagnosing concomitant esophageal conditions. Further studies are needed to determine the causal relationship between esophageal disorders and RC.