PERSISTENT UPPER RESPIRATORY DISEASES IN CHILDREN: ROLE OF GASTROESOPHAGEAL REFLUX STUDIED USING INTRALUMINAL IMPEDANCE AND PH

Abstract

BackgroundA variety of signs and symptoms of otolaryngological complaints have been attributed to gastroesophageal reflux disease (GERD). However, proof of such an association is spare. Recent studies suggest that in some cases GERD may be connected with upper respiratory diseases in children, and this paper explores the connection. The aim of the study was to estimate the incidence of GERD among children with persistent upper respiratory disease by inserting an electrode into the esophagus. Reflux can be detected as changes in intraluminal resistance brought on by liquid inside the esophagus, and pH measurements can be used to classify the reflux as acidic or nonacidic.Material and MethodsThis was a multicenter, prospective study of children (4–11.5 years old) with persistent upper respiratory disease. Chronic diseases such as allergy, asthma, cystic fibrosis, or congenital anomalies were excluded. The diagnosis of chronic upper tract disease was made by a single laryngologist. All children underwent a 24-hour multichannel intraluminal impedance and pH (MII–pH) study. The diagnosis of GERD was made with BioVIEW analysis software after manual review by a single investigator.ResultsExactly 31 consecutive patients (17 boys, 14 girls, mean age 6.8 years) were enrolled in the study. A diagnosis of GERD was made in 11/31 (35%) patients. A total of 1172 reflux episodes were detected by MII–pH, and 759 (65%) of them were acid, 413 (35%) were nonacid. The most common symptoms were mouth breathing (28/31), snoring (22/31), fetor ex ore (13/31), hawking (4/11), and apnea (2/11). None of the patients declared gastroenterological symptoms of GERD.ConclusionsThe incidence of GERD in children with persistent upper respiratory diseases was high (35%) in our group, but not as high as has been previously assessed. More than 1/3 of reflux episodes were non-acid. Reflux should be taken into consideration as a probable etiology of persistent upper respiratory diseases in children. 24-h pH and impedance monitoring is a more precise way of diagnosing GERD than classic pH-metry