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["Silent" gastroesophageal reflux and upper airway pathologies in childhood]
C De Vita1, F Berni Canani, B Cirillo
1Divisione O.R.L., Azienda Ospedaliera Santobono.
Insights
Gastroesophageal reflux (GER) is linked to pediatric airway issues, even without typical stomach symptoms. Early diagnosis via pH monitoring and laryngoscopy is crucial for managing these silent reflux cases in children.
Area of Science:
- Pediatric Otolaryngology
- Gastroenterology
- Pulmonology
Background:
- Gastroesophageal reflux (GER) is a significant factor in pediatric acute and chronic upper airway disorders.
- Diagnosing GER can be challenging, especially with "silent" GER presenting without obvious gastrointestinal symptoms.
- Upper airway symptoms like stridor, cough, and wheezing in children may be linked to GER.
Purpose of the Study:
- To investigate the association between GER and chronic/recurrent respiratory disorders of uncertain origin in pediatric patients.
- To evaluate the role of "silent" GER in children presenting with respiratory symptoms.
- To highlight the importance of specific diagnostic tools in identifying GER-related respiratory conditions.
Main Methods:
- Evaluation of 32 pediatric patients with chronic/recurrent upper respiratory symptoms and no gastrointestinal complaints.
- Outpatient 24-hour intraesophageal pH monitoring was performed on all patients.
- Pharyngo-laryngeal fibroscopy was conducted in 56% of the patients.
- Patients were stratified into two age groups: Group A (< 6 months) and Group B (> 6 months).
Main Results:
- All 32 patients tested positive for GER, with a mean Reflux Index of 21.5.
- Apnea-cyanosis and stridor were the most prevalent symptoms in younger children (Group A).
- Chronic cough was the predominant symptom in older children (Group B).
Conclusions:
- The study confirms a strong association between GER and respiratory diseases in children.
- GER-related respiratory symptoms show a correlation with patient age.
- Otolaryngological evaluations and 24-hour pH monitoring are essential for diagnosing silent GER in pediatric respiratory disorders.
Abstract:
In children, gastroesophageal reflux (GER) plays an important role in both acute and chronic upper airway disorders including stridor, chronic cough, recurrent upper respiratory infections, obstructive apnea, laryngospasm, and wheezing. Diagnosis may prove difficult unless there is reason to suspect GER and one is aware of the concept of "silent" GER. This paper presents our experience with chronic and/or recurrent respiratory disorders of uncertain origin and without gastrointestinal symptoms in children. Thirty-two pediatric patients with upper respiratory symptoms were evaluated. Out-patient 24-hour intraesophageal pH was monitored and 56% of the patients underwent pharyngo-laryngeal fibroscopy. The patients were divided into two subgroups: Group A (18 patients < 6 months of age) and Group B (14 patients > 6 months). All the patients tested positive for GER with a mean Reflux Index of 21.5. The most common symptoms in Group A were apnea-cianosis and stridor while they were chronic cough for group B. The present study confirms the association between GER and respiratory disease and between GER respiratory-related symptoms and patient age. Emphasis is placed on the importance of otolaryngological diagnostic procedures and 24-hour pH-gastroesophageal monitoring in evaluating patients with respiratory disorders related to silent GER.