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Pediatric Laryngopharyngeal Reflux: An Evidence-Based Review. CHILDREN 2023; 10:children10030583. [PMID: 36980141 PMCID: PMC10047907 DOI: 10.3390/children10030583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023]
Abstract
Purpose: Pediatric laryngopharyngeal reflux (P-LPR) is associated with the development of common otolaryngological symptoms and findings. In the present study, the findings about epidemiology, clinical presentation, diagnostic and therapeutic outcomes of pediatric population were reviewed. Methods: A PubMed, Cochrane Library, and Scopus literature search was conducted about evidence-based findings in epidemiology, clinical presentation, diagnostic and therapeutic outcomes of P-LPR. Findings: The prevalence of LPR remains unknown in infant and child populations. The clinical presentation depends on age. Infants with LPR symptoms commonly have both gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux and related digestive, respiratory and ear, nose and throat symptoms. The GERD prevalence appears to decrease over the growth, and the clinical picture is increasingly associated with LPR symptoms and findings without GERD. The prevalence of LPR and proximal acid and nonacid esophageal reflux events may be high in some prevalent otolaryngological conditions (chronic otitis media, laryngolomalacia and apnea). However, the lack of use of hypopharyngeal–esophageal multichannel intraluminal impedance pH monitoring (HEMII-pH) limits the establishment of etiological associations. Proton pump inhibitors are less effective in P-LPR patients compared to GERD populations, which may be related to the high prevalence of weakly or nonacid reflux events. Conclusions: Many gray areas persist in P-LPR and should be not resolved without the establishment of diagnostic criteria (guidelines) based on HEMII-pH. The unavailability of HEMII-pH and the poor acid-suppressive therapeutic response are all issues requiring future investigations. Future controlled studies using HEMII-pH and enzyme measurements in ear, nose or throat fluids may clarify the epidemiology of P-LPR according to age and its association with many otolaryngological conditions.
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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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Mozheiko TV, Ilchenko SI, Fialkovska АO, Koreniuk OS. SPECIFIC FEATURES OF THE ORAL MICROBIOME IN YOUNG CHILDREN WITH ARYNGOPHARYNGEAL REFLUX AND ITS ROLE THE DEVELOPMENT OF RECURRENT RESPIRATORY DISEASES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:58-64. [PMID: 36883491 DOI: 10.36740/wlek202301108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The aim: To examine the composition of the oral microbiome in young children with laryngopharyngeal reflux (LPR) and its role the development of recurrent respiratory diseases. PATIENTS AND METHODS Materials and methods: There were examined 38 children with physiological gastroesophageal reflux (GER), 18 children with LPR who had a medical history of recurrent bronchitis and 17 healthy children (control group). The study included the collection of anamnesis, objective examination. The qualitative and quantitative microbial composition of the upper respiratory tract was performed obtained by oropharyngeal deep swab. Salivary pepsin level and IL-8 were determined by enzyme-linked immunosorbent assay. RESULTS Results: This research showed significant alterations in the oral microbiome of patients with GER and LPR as compared to healthy control. We found that gram-negative microbiota such as Klebsiella pneumoniae, Escherichia coli, Proteus vulgaris, Proteus spp. and Candida albicans were identified in children with GER and LPR compared to the healthy control. At the same time, the amount of such a representative of the normal microbiome as Streptococcus viridans in children with LPR was sharply reduced. There were established a much higher mean salivary pepsin level of the patients with LPR than in the GER and control group. We found the association between high pepsin levels, saliva IL-8 levels and frequency of respiratory pathology in children with LPR. CONCLUSION Conclusions: Our study confirms that increased levels of pepsin in saliva are a risk factor for recurrent respiratory diseases in children with LPR.
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Restuti RD, Tamin S, Nugroho DA, Hutauruk SM, Mansyur M. Factors affecting the occurrence of otitis media with effusion in preschool and elementary school children: a comparative cross-sectional study. BMJ Open 2022; 12:e065291. [PMID: 36171035 PMCID: PMC9528613 DOI: 10.1136/bmjopen-2022-065291] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Identify the risk factors for otitis media with effusion (OME), especially laryngopharyngeal reflux (LPR), adenoid hypertrophy and allergic rhinitis, that could be used to develop prevention strategies in children. DESIGN A comparative cross-sectional study was conducted to make sure the adequacy of proportions of OME and non-OME cases in finding the related factors. SETTING History taking, ear/nose/throat (ENT) examination, and tympanometry were performed in preschool and elementary schools. Flexible fibreoptic nasopharyngolaryngoscopy was performed in a bronchoesophagology outpatient clinic in a tertiary referral hospital in Jakarta, Indonesia. PARTICIPANTS Preschool and elementary children in East Jakarta, Indonesia were recruited for this study. A total of 2016 participants underwent history taking, ENT examination and tympanometry. The case group was 46 children with OME, and the control group was 46 children without OME. The number of subjects fulfilled the minimum sample size for two proportions comparison. MAIN OUTCOME MEASURES A type B tympanogram indicated OME. A Reflux Finding Score of more than 7 indicated LPR. Adenoid hypertrophy was diagnosed using flexible fibreoptic nasopharyngolaryngoscopy. Allergic rhinitis was diagnosed using a questionnaire based on the International Study of Asthma and Allergies in Childhood phase III that has been validated for Indonesians. RESULTS The proportion of LPR in the OME group was significantly higher than in the non-OME group, at 78.3% and 52.2%. The probability of OME occurrence in patients with LPR was 3.3 times higher than in patients without LPR (OR 3.3; 95% CI 1.33 to 8.189; p=0.01). There was no significant relationship between adenoid hypertrophy and OME (p=0.211; 95% CI 0.71 to 3.97), and also between allergic rhinitis and OME (p=0.463; 95% CI 0.61 to 4.28). CONCLUSION The probability of OME occurrence in patients with LPR was 3.3 times higher than in patients without LPR. LPR should be considered in patients with OME and vice versa.
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Affiliation(s)
- Ratna Dwi Restuti
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Susyana Tamin
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dwi Agustawan Nugroho
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Syahrial Marsinta Hutauruk
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Muchtaruddin Mansyur
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Lechien JR, Hans S, Simon F, Horoi M, Calvo-Henriquez C, Chiesa-Estomba CM, Mayo-Yáñez M, Bartel R, Piersiala K, Nguyen Y, Saussez S. Association Between Laryngopharyngeal Reflux and Media Otitis: A Systematic Review. Otol Neurotol 2021; 42:e801-e814. [PMID: 33710157 DOI: 10.1097/mao.0000000000003123] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the relationship between laryngopharyngeal reflux (LPR) and recurrent (ROM) or chronic otitis media with effusion (COME). DATABASES PubMed, Scopus, and Cochrane Library. METHODS Three authors searched articles published between January 1980 and September 2020 about the association between LPR and the development of recurrent or chronic otitis media. Inclusion, exclusion, diagnostic criteria, and clinical outcome evaluation of included studies were analyzed using PRISMA criteria. The bias analysis of included studies was evaluated with the Tool to assess Risk of Bias of the CLARITY group. RESULTS Twenty-six clinical and three experimental articles met our inclusion criteria, accounting for 1,624 children and 144 adults with COME or ROM. According to the pH study type, the prevalence of LPR and gastroesophageal reflux disease (GERD) in OM patients were 28.7% (range, 8-100%) and 40.7 (range, 18-64%), respectively. The majority of studies identified pepsin or pepsinogen in middle ear effusion, with a range of mean concentrations depending on the technique used to measure pepsin. There was an important heterogeneity between studies regarding definition of COME, ROM, and LPR, exclusion criteria, methods used to measure pepsin/pepsinogen in middle ear secretions and outcome assessments. CONCLUSION The association between LPR and OM is still unclear. Future clinical and experimental studies are needed to investigate the association between LPR and OM in both children and adults through extensive gastric content analysis in middle ear suppurations and impedance-pH monitoring considering acid, weakly acid, and alkaline reflux events.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Ambroise Paré Hospital (APHP), Paris Saclay University, Paris, France
- Department of Otolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University
| | - Stéphane Hans
- Department of Otolaryngology-Head and Neck Surgery, Ambroise Paré Hospital (APHP), Paris Saclay University, Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, Paris Saclay University
| | - Francois Simon
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Pediatric Otolaryngology - Head and Neck Surgery Department, Necker-Enfants Malades Hospital, Paris, France
| | - Mihaela Horoi
- Department of Otolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Christian Calvo-Henriquez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela
| | - Carlos M Chiesa-Estomba
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Universitario Donostia, San Sebastian
| | - Miguel Mayo-Yáñez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology - Head and Neck Surgery, Complexo Hospitalario Universitario A Coruña (CHUAC), 15006, A Coruña, Galicia
- Clinical Research in Medicine, International Center for Doctorate and Advanced Studies (CIEDUS), Universidade de Santiago de Compostela (USC), 15782, Santiago de Compostela, Galicia
| | - Ricardo Bartel
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Universitario Mutua Terrasa, Barcelona, Spain
| | - Krzysztof Piersiala
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Yann Nguyen
- Groupe Hospitalo-Universitaire Pitié Salpêtrière, Otorhinolaryngology Department, Unit of Otology, Auditory Implants and Skull Base Surgery, Sorbonne Université, Paris, France
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium
- Department of Otolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
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Samuels TL, Khampang P, Espahbodi M, McCormick CA, Chun RH, McCormick ME, Yan K, Kerschner JE, Johnston N. Association of Pepsin With Inflammatory Signaling and Effusion Viscosity in Pediatric Otitis Media. Laryngoscope 2021; 132:470-477. [PMID: 34272879 DOI: 10.1002/lary.29749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/11/2021] [Accepted: 07/06/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Otitis media (OM) is a common inflammatory disease spectrum. Cytokine signaling, neutrophil activity, and mucin hypersecretion during recurrent and chronic OM contribute to persistent, viscous middle ear (ME) effusions, hearing loss, and potential for developmental delay. Extraesophageal reflux (EER), specifically pepsin, triggers inflammatory signaling in respiratory mucosa and is associated with OM. The objective of this study was to investigate the association of pepsin with ME inflammatory signaling and the outcomes and examine causality in vitro. STUDY DESIGN Cross-sectional study. METHODS ME fluid (MEF) and preoperative audiometric data were collected from 30 pediatric subjects undergoing tympanostomy tube placement for recurrent OM or OM with effusion. MEF viscosity was characterized by the surgeon. Pepsin, inflammatory molecules, and mucin were assayed by enzyme-linked immunosorbent assay (ELISA). ME epithelial primary culture was exposed to 0.1 to 1 mg/ml pepsin at pH 5, 6, and 7 for 30 minutes, and cytokine expression was assayed via qPCR. RESULTS Pepsin was observed in the MEF of 77% of patients (range 71-2,734 ng/ml). Pepsin correlated with effusion viscosity, interleukins -6 and -8, neutrophil elastase, and mucin 5B (P < .05). Pepsin-negative MEF was more frequently absent of interleukin 8 or mucin 5B (P < .05). Weak acid was generally insufficient to elicit cytokine expression in ME cells in vitro, however, pepsin induced IL6, IL8, and TNF at pH 7 (P < .05) and weak acid (pH 6) facilitated a response at lower pepsin concentration. CONCLUSIONS Pepsin may contribute to inflammatory signaling, persistent viscous effusion, and poorer OM outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Tina L Samuels
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Pawjai Khampang
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Mana Espahbodi
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Caroline A McCormick
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Robert H Chun
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Michael E McCormick
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Ke Yan
- Pediatrics Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Joseph E Kerschner
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Nikki Johnston
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.,Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
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Liu D, Qian T, Sun S, Jiang JJ. Laryngopharyngeal Reflux and Inflammatory Responses in Mucosal Barrier Dysfunction of the Upper Aerodigestive Tract. J Inflamm Res 2021; 13:1291-1304. [PMID: 33447069 PMCID: PMC7801919 DOI: 10.2147/jir.s282809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022] Open
Abstract
The upper aerodigestive tract (UAT) is the first line of defense against environmental stresses such as antigens, microbes, inhalants, foods, etc., and mucins, intracellular junctions, epithelial cells, and immune cells are the major constituents of this defensive mucosal barrier. Laryngopharyngeal reflux (LPR) is recognized as an independent risk factor for UAT mucosal disorders, and in this review, we describe the components and functions of the mucosal barrier and the results of LPR-induced mucosal inflammation in the UAT. We discuss the interactions between the refluxate and the mucosal components and the mechanisms through which these damaging events disrupt and alter the mucosal barriers. In addition, we discuss the dynamic alterations in the mucosal barrier that might be potential therapeutic targets for LPR-induced disorders.
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Affiliation(s)
- Danling Liu
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China
| | - Tingting Qian
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China
| | - Shan Sun
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China
| | - Jack J Jiang
- Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China.,Department of Surgery, Division of Otolaryngology Head and Neck Surgery, University of Wisconsin Medical School, Madison, WI 53792-7375, USA
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Pang K, Di Y, Li G, Li J, Li X, Sun L. Can Reflux Symptom Index and Reflux Finding Score Be Used to Guide the Treatment of Secretory Otitis Media in Adults? ORL J Otorhinolaryngol Relat Spec 2020; 82:130-138. [PMID: 32079018 DOI: 10.1159/000505929] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND At present more attention is paid to the treatment of secretory otitis media in children, but there is also a high incidence of adult patients. The etiology of secretory otitis media in adults is complex and related to many factors. OBJECTIVES The aim of this study was to evaluate the correlation between the Reflux Symptom Index (RSI)/Reflux Finding Score (RFS) and secretory otitis media in adults, and to explore further treatment methods. MATERIAL AND METHODS Taking outpatients in the otology department from January 2017 to May 2019 as the object of study, acoustic immittance tests were performed and the results analyzed. Patients with secretory otitis media received tympanocentesis or tympanotomy and the related components were analyzed.The patients were followed up and the curative effects of different treatment schemes were compared. RESULTS There were 67 patients with secretory otitis media. The prevalence of secretory otitis media in patients with RSI >13 was significantly higher than that in patients with RSI <13. The prevalence of secretory otitis media in patients with RFS >7 was significantly higher than that in patients with RFS <7 (p < 0 05). The RSI/RFS score of B tympanogram was significantly higher than that of A and C maps (p < 0.05). Among the patients with type B, the serous type was higher in those with an RSI score <13, and the mucus was higher in those with an RSI score >13 (p < 0.05). There was no significant difference in the proportion of glue patients (p > 0.05). In type B patients, the detection rate of pepsin in the experimental group was significantly higher than that in the control group (p < 0.05), and the scores of RSI/RFS in the pepsin-positive group were significantly higher than those in the negative group (p < 0.05). Treatment with acid-suppressive drugs in patients with abnormal RSI/RFS achieved better results (p < 0.05). CONCLUSIONS RSI/RFS may be related to the development of secretory otitis media in adults, and could play a guiding role in its treatment.
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Affiliation(s)
- Kaiyun Pang
- Department of Otolaryngology, Kaifeng Hospital of Traditional Chinese Medicine, Kaifeng, China.,Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Yuanzhi Di
- Department of Otolaryngology, Xinjiang Production and Construction Corps Hospital, Xinjiang, China
| | - Guodong Li
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, China,
| | - Jianfeng Li
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Xin Li
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Lu Sun
- Department of Otolaryngology, Shanxi Provincial People's Hospital Affiliated to Shanxi Medical University, Taiyuan, China
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Ghisa M, Della Coletta M, Barbuscio I, Marabotto E, Barberio B, Frazzoni M, De Bortoli N, Zentilin P, Tolone S, Ottonello A, Lorenzon G, Savarino V, Savarino E. Updates in the field of non-esophageal gastroesophageal reflux disorder. Expert Rev Gastroenterol Hepatol 2019; 13:827-838. [PMID: 31322443 DOI: 10.1080/17474124.2019.1645593] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Gastroesophageal reflux disease (GERD) is one of the most prevalent conditions in Western Countries, normally presenting with heartburn and regurgitation. Extra-esophageal (EE) GERD manifestations, such as asthma, laryngitis, chronic cough and dental erosion, represent the most challenging aspects from diagnostic and therapeutic points of view because of their multifactorial pathogenesis and low response to proton pump inhibitors (PPIs). In fact, in the case of EE, other causes must by preventively excluded, but instrumental methods, such as upper gastrointestinal endoscopy and laryngoscopy, have low specificity and sensitivity as diagnostic tools. In the absence of alarm signs and symptoms, empirical therapy with a double-dose of PPIs is recommended as a first diagnostic approach. Subsequently, impedance-pH monitoring could help to define whether the symptoms are GERD-related. Areas covered: This article reviews the current literature regarding established and proposed EE-GERD, reporting on all available options for its correct diagnosis and therapeutic management. Expert opinion: MII-pH could help to identify a hidden GERD that causes EE. Unfortunately, standard MII-pH analysis results are often unable to define this association. New parameters such as the mean nocturnal baseline impedance and post-reflux swallow-induced peristaltic wave index may have an improved diagnostic yield, but prospective studies using impedance-pH are needed.
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Affiliation(s)
- Matteo Ghisa
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - Marco Della Coletta
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - Ilenia Barbuscio
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - Elisa Marabotto
- Gastrointestinal Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa , Italy
| | - Brigida Barberio
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | | | - Nicola De Bortoli
- Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa , Pisa , Italy
| | - Patrizia Zentilin
- Gastrointestinal Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa , Italy
| | - Salvatore Tolone
- Surgery Unit, Department of Surgery, University of Campania Luigi Vanvitelli , Caserta , Italy
| | - Andrea Ottonello
- Department of Surgical Science and Integrated Diagnostics, University of Genoa , Genoa , Italy
| | - Greta Lorenzon
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - Vincenzo Savarino
- Gastrointestinal Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa , Italy
| | - Edoardo Savarino
- Gastrointestinal Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
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Bongiovanni A, Parisi GF, Scuderi MG, Licari A, Brambilla I, Marseglia GL, Leonardi S. Gastroesophageal reflux and respiratory diseases: does a real link exist? Minerva Pediatr 2019; 71:515-523. [PMID: 31129955 DOI: 10.23736/s0026-4946.19.05531-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Gastro-esophageal reflux disease (GERD) indicates a gastroesophageal reflux that causes symptoms such as pain, and needs medical therapy, and may result in complications such as erosive esophagitis, aspiration pneumonia. Here, we review if it exists a real link between clinical presentation of some respiratory diseases such as asthma, chronic cough, cystic fibrosis and laryngopharyngitis and GERD. EVIDENCE ACQUISITION This review was conducted employing 2 databases: PubMed and Science Direct. EVIDENCE SYNTHESIS Asthma may lead to reflux, and reflux could exacerbate asthma or cause asthma-like symptoms. Prevalence of GERD in children with asthma ranged from as low 32% to as high 80%. There are several studies where the use of proton pump inhibitors (PPIs) and histamine H2 receptor antagonists lead to inconclusive results. The relation of chronic unexplained cough to GERD remains controversial in children and pediatric guidelines do not currently recommend empirical GERD treatment trials for pediatric chronic cough. Gastroesophageal reflux is more frequent in patients with cystic fibrosis (CF) than general population. Although PPIs are regularly prescribed in approximately half of the patients with CF, there are no specific guidelines for treatment of reflux in CF and it was shown that chronic treatment with PPIs was correlated to possible increased risk of exacerbations. CONCLUSIONS The pathogenesis of GER-related respiratory symptoms is multifactorial. The causal relationship between these two conditions may be difficult to prove also with the aid of supporting tests. Multichannel intraluminal impedance associated with pH-metry (pH/MII) detect all gastroesophageal reflux episodes accompanied with a bolus movement and classify GER episodes according to their content (liquid, gas and mixed), pH value and proximal extension. There are no consistent evidences confirming the validity of medical therapy in reflux with respiratory symptoms.
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Affiliation(s)
- Annarita Bongiovanni
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giuseppe F Parisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy -
| | - Maria G Scuderi
- Department of Medical, Surgical Sciences and Advanced Technologies, University of Catania, Catania, Italy
| | - Amelia Licari
- Department of Pediatrics, San Matteo Polyclinic Hospital, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Ilaria Brambilla
- Department of Pediatrics, San Matteo Polyclinic Hospital, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Gian L Marseglia
- Department of Pediatrics, San Matteo Polyclinic Hospital, IRCCS and Foundation, University of Pavia, Pavia, Italy
| | - Salvatore Leonardi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Pavić I, Babić I, Matijašić N, Hojsak I. Combined multichannel intraluminal impedance-pH monitoring should be used to diagnose reflux-related otitis media with effusion in children. Acta Paediatr 2018; 107:1642-1647. [PMID: 29603354 DOI: 10.1111/apa.14339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/26/2017] [Accepted: 03/22/2018] [Indexed: 12/14/2022]
Abstract
AIM This study investigated the diagnostic usefulness of combined multichannel intraluminal impedance-pH monitoring (MII-pH) in children with suspected reflux-related otitis media with effusion (OME) as existing data were scarce. METHODS This was a prospective study that included children up to seven years of age who underwent MII-pH due to OME lasting more than three months. The study was conducted in the Children's Hospital Zagreb, Croatia, from January 2014 to August 2016. RESULTS The study comprised 63 children (63% male) with a mean age of 4.7 years. Gastroesophageal reflux (GER) disease was detected by impedance in 22 (35%) of the children and by pH-metry in nine (14%). In children with OME, MII-pH found a median number of 24 proximal GER episodes, of which a median of nine was acidic and a median of 11 was weakly acidic. There was a significant positive correlation between the number of GER episodes and the presence of eosinophils in nasal swabs. CONCLUSION Both acidic and weakly acidic refluxes seemed to play a significant role in the pathogenesis of OME. Localised nasal eosinophilia may serve as a marker of extraoesophageal reflux in children with suspected reflux-related OME.
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Affiliation(s)
- Ivan Pavić
- Department of Pulmonology, Allergology and Immunology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Irena Babić
- Otorhinolaryngology Department, Children's Hospital Zagreb, Zagreb, Croatia
| | - Nuša Matijašić
- Department of Pulmonology, Allergology and Immunology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Iva Hojsak
- Referral Centre for Paediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, Zagreb, Croatia
- University of Zagreb School of Medicine, Zagreb, Croatia
- University J.J. Strossmayer School of Medicine Osijek, Osijek, Croatia
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Kubba H. The Role of Reflux in Childhood Otorhinolaryngological Disorders. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0179-3] [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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Han SY, Kim GH. Clinical Manifestations of Laryngopharyngeal Reflux. J Neurogastroenterol Motil 2016; 22:351-2. [PMID: 27354034 PMCID: PMC4930291 DOI: 10.5056/jnm16093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/13/2016] [Indexed: 01/01/2023] Open
Affiliation(s)
- Sung Yong Han
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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