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Pediatric Laryngopharyngeal Reflux in the Last Decade: What Is New and Where to Next? J Clin Med 2023; 12:jcm12041436. [PMID: 36835970 PMCID: PMC9962831 DOI: 10.3390/jcm12041436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Laryngopharyngeal reflux may affect people of any age; still, most of the accumulated knowledge concerns adults, and evidence regarding pediatric populations remains relatively restricted. This study aims to review the most recent and emerging aspects of pediatric laryngopharyngeal reflux from the last ten years. It also attempts to identify gaps in knowledge and highlight discrepancies that future research should urgently address. METHODS An electronic search of the MEDLINE database was conducted, limited to January 2012 through December 2021. Non-English language articles, case reports, and studies that concerned a purely or predominantly adult population were excluded. The information from the articles with the most relevant contribution was initially categorized by theme and subsequently synthesized into a narrative form. RESULTS 86 articles were included, of which 27 were review articles, eight were surveys, and 51 were original articles. Our review systematically maps the research done in the last decade and provides an updated overview and the current state-of-the-art in this subject. CONCLUSIONS Despite discrepancies and heterogeneity in accumulating research, evidence gathered so far endorses a need for refining an escalating multiparameter diagnostic approach. A step-wise therapeutic plan appears to be the most reasonable management approach, starting with behavioral changes for mild to moderate, uncomplicated cases and escalating to personalized pharmacotherapy options for severe or nonresponsive cases. Surgical options could be considered in the most severe cases when potentially life-threatening symptoms persist despite maximal medical therapy. Over the past decade, the amount of available evidence has been gradually increasing; however, its strength remains low. Several aspects remain markedly under-addressed, and further adequately powered, multicenter, controlled studies with uniformity in diagnostic procedures and criteria are urgently needed.
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Singendonk MMJ, Pullens B, van Heteren JAA, de Gier HHW, Hoeve HLJ, König AM, van der Schroeff MP, Hoekstra CEL, Veder LL, van der Pol RJ, Benninga MA, van Wijk MP. Reliability of the reflux finding score for infants in flexible versus rigid laryngoscopy. Int J Pediatr Otorhinolaryngol 2016; 86:37-42. [PMID: 27260577 DOI: 10.1016/j.ijporl.2016.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The Reflux Finding Score for Infants (RFS-I) was developed to assess signs of laryngopharyngeal reflux (LPR) in infants. With flexible laryngoscopy, moderate inter- and highly variable intraobserver reliability was found. We hypothesized that the use of rigid laryngoscopy would increase reliability and therefore evaluated the reliability of the RFS-I for flexible versus rigid laryngoscopy in infants. METHODS We established a set of videos of consecutively performed flexible and rigid laryngoscopies in infants. The RFS-I was scored twice by 4 otorhinolaryngologists, 2 otorhinolaryngology fellows, and 2 inexperienced observers. Cohen's and Fleiss' kappas (k) were calculated for categorical data and the intraclass correlation coefficient (ICC) was calculated for ordinal data. RESULTS The study set consisted of laryngoscopic videos of 30 infants (median age 7.5 (0-19.8) months). Overall interobserver reliability of the RFS-I was moderate for both flexible (ICC = 0.60, 95% CI 0.44-0.76) and rigid (ICC = 0.42, 95% CI 0.26-0.62) laryngoscopy. There were no significant differences in reliability of overall RFS-I scores and individual RFS-I items for flexible versus rigid laryngoscopy. Intraobserver reliability of the total RFS-I score ranged from fair to excellent for both flexible (ICC = 0.33-0.93) and rigid (ICC = 0.39-0.86) laryngoscopies. Comparing RFS-I results for flexible versus rigid laryngoscopy per observer, reliability ranged from no to substantial (k = -0.16-0.63, mean k = 0.22), with an observed agreement of 0.08-0.35. CONCLUSION Reliability of the RFS-I was moderate and did not differ between flexible and rigid laryngoscopies. The RFS-I is not suitable to detect signs or to guide treatment of LPR in infants, neither with flexible nor with rigid laryngoscopy.
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Affiliation(s)
- Maartje M J Singendonk
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
| | - Bas Pullens
- Department of Otorhinolaryngology and Head and Neck Surgery, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan A A van Heteren
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Henriëtte H W de Gier
- Department of Otorhinolaryngology and Head and Neck Surgery, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hans L J Hoeve
- Department of Otorhinolaryngology and Head and Neck Surgery, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Astrid M König
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc P van der Schroeff
- Department of Otorhinolaryngology and Head and Neck Surgery, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Carlijn E L Hoekstra
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Laura L Veder
- Department of Otorhinolaryngology and Head and Neck Surgery, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rachel J van der Pol
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Marc A Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Michiel P van Wijk
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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Galluzzi F, Schindler A, Gaini RM, Garavello W. The assessment of children with suspected laryngopharyngeal reflux: An Otorhinolaringological perspective. Int J Pediatr Otorhinolaryngol 2015; 79:1613-9. [PMID: 26279249 DOI: 10.1016/j.ijporl.2015.07.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 07/26/2015] [Accepted: 07/27/2015] [Indexed: 12/24/2022]
Abstract
The assessment of pediatric laryngopharyngeal reflux (LPR) is controversial. Otorhinolaryngologists may play a role in the evaluation of children with suspected LPR detecting typical airway endoscopic findings and/or associated diseases and may help in the selection of children to be subjected to further instrumental tests. In this perspective the present review aims at examining the available evidence in the literature regarding the assessment of LPR in children. After careful literature search there are no current validated symptoms assessment questionnaires for LPR evaluation in children; flexible fiberoptic nasopharyngolaryngoscopy remains controversial as a diagnostic tool in suspect LPR cases; even though the multichannel intraluminal impedance with pH monitoring has been proposed as the instrumental gold standard, further evidence need to be found for validation in children with typical features of LPR.
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Affiliation(s)
| | - Antonio Schindler
- Phoniatric Unit, Department of Biomedical and Clinical Sciences "L. Sacco," University of Milan, Milan, Italy
| | - Renato Maria Gaini
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy
| | - Werner Garavello
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy; Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy
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Baudoin T, Kosec A, Cor IS, Zaja O. Clinical features and diagnostic reliability in paediatric laryngopharyngeal reflux. Int J Pediatr Otorhinolaryngol 2014; 78:1101-6. [PMID: 24833166 DOI: 10.1016/j.ijporl.2014.04.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/08/2014] [Accepted: 04/11/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to assess the validity of current diagnostic approaches in pediatric laryngopharyngeal reflux (PLPR). Clinical status findings and 24h double probe oesophageal pH monitoring results in children with suspected PLPR and/or GERD were analyzed and a clinically useful probability score was developed. METHODS This is a retrospective longitudinal cohort study including 89 pediatric patients who underwent preliminary oropharyngoscopy, and then nasal fibre optic laryngoscopy and ambulatory 24h oesophageal pH monitoring in a tertiary pediatric and otorhinolaryngology hospital center. The patients' parents gave written informed consent for diagnostic testing. Statistical analysis was performed using standard descriptive statistics. Associations between variables were assessed using Fisher's exact test, Mann-Whitney test and Kruskal-Wallis test for non-parametric paired samples. RESULTS Patients' age spanned 1-18 years with a median of 11.2. Out of the 89 patients, 56 were girls, and 33 were boys. All of the patients underwent nasal fibre optic laryngoscopy and 24h double probe pH monitoring. Out of 89 examined children, 50 had PLPR. Out of the 50 positive for PLPR, 46 had a positive clinical finding, with a sensitivity of 92% (95% CI: 80.75-97.73%) and specificity of 10.26% (95% CI: 2.93-24.24%). Boys have GERD significantly more often than girls (p<0.0001), and have a worse result of pH monitoring (p<0.0001). The most common finding was an injected and granulated oropharynx accompanied by posterior laryngitis (54/89). Patients with leading symptoms of asthma had significantly worse GERD scores (p=0.0493). The patients were then reassigned to newly developed risk categories and a significant correlation with a positive PLPR diagnosis was found (p=0.0262). CONCLUSIONS The significance of a thorough otorhinolaryngologic and paediatric examination and patient history taking is still paramount, with additional benefit in diagnosing the disease arising from 24h oesophageal pH monitoring in select patients. This study brings to light new relationships between clinical symptoms and objective findings and presents a novel attempt to classify the likelihood of diagnosis. Patient stratification could help clinicians in defining groups at high risk and support a timely, cost-effective and precise diagnostic evaluation and proper therapy.
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Affiliation(s)
- Tomislav Baudoin
- Department of Otorhinolarygology and Head and Neck Surgery, Clinical Hospital Centre Sestre milosrdnice, Zagreb University School of Medicine, Vinogradska cesta 29, Zagreb, Croatia.
| | - Andro Kosec
- Department of Otorhinolarygology and Head and Neck Surgery, Clinical Hospital Centre Sestre milosrdnice, Zagreb University School of Medicine, Vinogradska cesta 29, Zagreb, Croatia.
| | | | - Orjena Zaja
- Department of Pediatrics, Clinical Hospital Centre Sestre milosrdnice, Zagreb University School of Medicine, Vinogradska cesta 29, Zagreb, Croatia
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Goessler A. Gastroesophageal reflux in children – news, trends and standards. Eur Surg 2012. [DOI: 10.1007/s10353-012-0104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ozmen S, Demirceken F, Barut Y, Dibek Misirlioglu E. Role of laryngoscopy in children with respiratory complaints and suspected reflux. Allergol Immunopathol (Madr) 2012; 40:204-9. [PMID: 21978888 DOI: 10.1016/j.aller.2011.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 06/04/2011] [Accepted: 06/14/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND In recent years, laryngopharyngeal reflux (LPR) in children has been taken into consideration. OBJECTIVE The aim of this study was to assess the laryngoscopic findings in children diagnosed LPR and/or gastro-oesophageal reflux (GERD). METHODS The findings of 49 patients with at least one or more respiratory complaint such as chronic cough, wheezing, hoarseness, recurrent laryngitis, and throat clearing/postnasal discharge suggesting LPR were evaluated retrospectively. The diagnosis of LPR+GERD or GERD was done by the clinical history and 24 h double-probe pH monitoring and/or scintigraphy. RESULTS Thirty eight out of 49 patients examined by laryngoscopy underwent 24 h double-probe pH monitoring and/or scintigraphy. Thirty of them were diagnosed as LPR+GERD or GERD by any test positivity. Twelve of 30 patients diagnosed with LPR+GERD or GERD had a positive laryngeal finding on the examination of fibre optic laryngoscopy. The most common finding with eight cases was arytenoid erythema A sensitivity of 40% and specificity of 50% for the laryngoscopy in the diagnosis of LPR/GERD were found. CONCLUSION In children with unexplained respiratory symptoms, laryngopharyngeal reflux should be suspected. Therefore, until enough data on this issue in the literature accumulates, the history and the laboratory findings of the patients obtained from various techniques to document paediatric LPR should be evaluated together.
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May JG, Shah P, Lemonnier L, Bhatti G, Koscica J, Coticchia JM. Systematic Review of Endoscopic Airway Findings in Children with Gastroesophageal Reflux Disease. Ann Otol Rhinol Laryngol 2011; 120:116-22. [DOI: 10.1177/000348941112000208] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: We performed a systematic review of published literature correlating findings on endoscopic evaluation of the larynx and trachea in the pediatric population with the incidence of gastroesophageal reflux disease. Methods: Eight articles were identified through a structured PubMed search of English-language literature using the key terms laryngopharyngeal reflux, extraesophageal reflux, and gastroesophageal reflux. A systematic review was performed relating the presence of reflux in the pediatric population to findings on endoscopic airway evaluation. A covariant analysis was performed, and each study was weighted according to the number of available samples in that study as a fraction of the total. Overall odds ratios and confidence intervals were computed for each endoscopic finding on the basis of the documented absence or presence of gastroesophageal reflux disease. Results: A correlation was seen between the endoscopic findings and the presence of reflux. Conclusions: Arytenoid, postglottic, and vocal fold edema and erythema, lingual tonsil hypertrophy, laryngomalacia, and subglottic stenosis are among the endoscopic findings most frequently identified in patients with gastroesophageal reflux disease. Certain findings commonly encountered on endoscopic evaluation of the larynx and trachea in children who present with respiratory symptoms do indeed demonstrate a correlation with the presence of laryngopharyngeal reflux disease and may indicate the need for antireflux therapy.
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Management of oropharyngeal dysphagia in the neurologically intact and developmentally normal child. Curr Opin Otolaryngol Head Neck Surg 2010; 18:554-63. [DOI: 10.1097/moo.0b013e32834029de] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kotby MN, Hassan O, El-Makhzangy AMN, Farahat M, Shadi M, Milad P. Gastroesophageal reflux/laryngopharyngeal reflux disease: a critical analysis of the literature. Eur Arch Otorhinolaryngol 2009; 267:171-9. [DOI: 10.1007/s00405-009-1176-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Accepted: 11/27/2009] [Indexed: 01/28/2023]
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Abstract
PURPOSE OF REVIEW To emphasize oral complications in children with gastroesophageal reflux disease. Interest of pediatricians to conduct an orodental examination or to include a dental examination performed by a dentist should be encouraged, as dental erosion, for instance, may be present in these children. RECENT FINDINGS Dental caries, dental erosion, mucosal lesions and oral bacterial load have been studied extensively in children with gastroesophageal reflux disease, but there is no sound consensus about the impact of gastroesophageal reflux disease on oral health parameters. SUMMARY Gastroesophageal reflux and oral health deserve to be better understood and recognized by medical staff, pediatricians in particular. Literature on this subject contains many case reports and some cross-sectional studies, resulting in confusing conclusions for clinicians and researchers. Dental caries, dental erosion, mucosal lesions and oral bacterial load are the most frequently studied items in these kinds of study. Dental erosion seems to be an oral finding that should be studied in depth in these children, as conflicting results have been reported in literature, the latter being the result of the use of different indexes to collect clinical data.
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Affiliation(s)
- Evelyn Vega Alfaro
- Department of Pediatric Dentistry and Centre for Special Care, Ghent University, Dental School, Ghent, Belgium
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Pathophysiological mechanisms of extraesophageal reflux in otolaryngeal disorders. Eur Arch Otorhinolaryngol 2008; 266:17-24. [DOI: 10.1007/s00405-008-0770-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 07/03/2008] [Indexed: 12/19/2022]
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Monroy A, Behar P, Brodsky L. Revision adenoidectomy--a retrospective study. Int J Pediatr Otorhinolaryngol 2008; 72:565-70. [PMID: 18295352 DOI: 10.1016/j.ijporl.2008.01.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 12/26/2007] [Accepted: 01/02/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adenoid "re-growth" is a poorly understood phenomenon. While parents often express concerns regarding the potential for adenoid "re-growth", little information exists in the literature about its incidence and causation. PURPOSE To establish the incidence and possible contributing factors leading to adenoid re-growth in children. DESIGN Retrospective case series review. SETTING Tertiary care children's hospital. METHODS The charts of 106 patients who underwent revision adenoidectomy between 1995 and 2006 were reviewed. Thirty-four patients were excluded because the primary adenoidectomy was performed elsewhere or initially only a partial adenoidectomy was performed. In the remaining 72 patients, demographic data, clinical presentation, associated medical conditions and findings at surgery were studied. RESULTS During the 11-year study period. 13,005 adenoidectomies or adenotonsillectomies were performed; 72/13,005 (0.55%) underwent revision adenoidectomy. The mean (+/-S.D.) age at presentation for primary adenoidectomy was 3.68+/-2.9 and 7.69+/-4.04 years for secondary ("revision") adenoidectomy with an average time interval of 4.3 years between surgeries. Age at initial adenoidectomy was not a significant factor in predicting revision adenoid surgery. 29/72 (40%) underwent a reflux work up including scintiscan with gastric emptying, 24h pH probe, or laryngoscopy. 28/29 (96%) were diagnosed with reflux. At least 15/72 (21%) were reported to have symptoms consistent with adenoid re-growth which were found to be caused by tubal tonsil hyperplasia. CONCLUSIONS Revision adenoidectomy rarely needs to be performed. Tubal tonsillar hyperplasia, as opposed to re-growth of residual adenoid tissue previously removed, accounts for some cases. Extraesophageal reflux is a possible cause in some and requires further study.
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Affiliation(s)
- Angelo Monroy
- Department of Otolaryngology, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, NY 14202, United States
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Ulualp SO, Brodsky L. Monitoring of gastric acid suppression in patients with extraesophageal reflux disease. Int J Pediatr Otorhinolaryngol 2007; 71:1849-53. [PMID: 17889942 DOI: 10.1016/j.ijporl.2007.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Revised: 08/15/2007] [Accepted: 08/16/2007] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Response to acid suppressive therapy varies in patients with extraesophageal esophageal reflux disease (EERD). Inadequate suppression of gastric acid may contribute to the observed differences in the response to the treatment. The aim of this study was to evaluate suppression of gastric acid in EERD patients being treated with acid suppressive therapy. METHODS Charts of patients with EERD who underwent dual channel 24h esophageal pH monitoring while receiving acid suppressive therapy between January 2002 and June 2004 were reviewed. Suppression of gastric acid was determined based on the number of acid reflux episodes, esophageal acid exposure, and acid clearance time. RESULTS Twenty patients (12 male, 8 female, age range: 2-19 years) were identified. Esophageal pH monitoring was within normal limits, documenting complete acid suppression in nine patients (45%). Increased numbers of acid reflux episodes were observed in seven patients. In four patients, the number of acid reflux episodes was normal in spite of incomplete acid suppression. However, other abnormal pH monitoring parameters included delayed acid clearance in three patients and increased acid exposure time in three. The majority of patients also showed alkaline reflux. CONCLUSION Esophageal pH monitoring documented incomplete acid suppression in this group of infants, children, adolescents and teens with EERD. Monitoring of gastric acid suppression can be useful in guiding the follow-up of EERD patients who receive acid suppressive therapy.
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Affiliation(s)
- Seckin O Ulualp
- Division of Pediatric Otolaryngology, UTMB Children's Hospital, University of Texas Medical Branch, Galveston, TX 77555-0521, United States.
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Mitzner R, Brodsky L. Multilevel esophageal biopsy in children with airway manifestations of extraesophageal reflux disease. Ann Otol Rhinol Laryngol 2007; 116:571-5. [PMID: 17847723 DOI: 10.1177/000348940711600803] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Extraesophageal reflux disease (EERD) is a recognized cause of upper airway symptoms in children. Direct microlaryngoscopy and bronchoscopy (MLB) is performed for diagnostic information as to the extent and severity of the inflammation caused by gastric refluxate. Esophagoscopy with multilevel biopsy performed at the time of MLB may provide the clinician with additional information to assist in the management of EERD. We undertook to determine the role of multilevel esophageal biopsy in children who have airway manifestations secondary to EERD. METHODS We performed a retrospective chart review of 139 esophagoscopies with multilevel biopsy done at the time of MLB by a single provider for evaluation of symptoms highly associated with EERD at a tertiary care children's hospital. The histopathologic presence of esophagitis was analyzed by site and compared to the presence and location of tracheolaryngeal abnormalities. RESULTS Tracheolaryngeal abnormalities associated with EERD were found in 97% of patients when evaluated by MLB. Concomitant esophagitis was found in 59% of these patients. Of patients who had 0, 1, 2, 3, 4, or 5 positive findings on MLB, 75% (3 of 4), 58% (7 of 12), 57% (20 of 35), 62% (32 of 51), 56% (18 of 32), and 80% (4 of 5), respectively, had at least 1 positive biopsy. CONCLUSIONS We found that EERD that affects the pediatric upper airway was associated with esophagitis in more than half of the patients. The usefulness of 4-level biopsies during esophagoscopy and concomitant airway endoscopy will be discussed.
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Affiliation(s)
- Ron Mitzner
- Department of Otolaryngology, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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