Current standards.pptVIP

Current standards of care in the diagnosis and treatment of extraesophageal reflux in children Grand Rounds October 10, 2007 S Kherani Objectives Define extra-esophageal reflux disease and differentiate it from GERD Describe the various clinical presentations of EERD Identify and compare methods for diagnosing EERD Discuss management strategies for EERD Extra-esophageal Reflux (EER) When stomach contents emerge from the esophagus into the upper and lower airways, nose, nasopharynx and oral cavity Refluxate acid, pepsin, bile and pancreatic enzymes GERD vs EERD Extra-esophageal Reflux Disease(EERD) When refluxate results in a 2o disease Ex: rhinosinusitis, chronic laryngitis, recurrent pneumonia, asthma GERD and EERD have same root cause (mucosal irritation from refluxate), but the characteristics of the damaged mucosa and their anatomic relationships differ GERD vs EERD Esophagus protected from refluxate by frequent swallows that clear esophagus Buffering action of saliva Squamous epithelium Tonic contraction of LES Brief refluxate exposure can have no effect on esophagus Upper aerodigestive tract protected by: Length of esophagus Esophagus peristalsis UES Damage with even brief refluxate exposure to upper aerodigestive and lower a/w Little et al. showed in an animal model that acid exposure of 1 minute/d x 8d changed minor tracheal injury ? subglottic stenosis Damage can occur with exposure pH4 (pepsin active at pH of 6.5) Epidemiology GERD Adults: 75 million in US have GERD, 50% of these also have EER Pediatrics: 1.8%-22% have GERD Genetic association to chromosome 13q14 for some Begins as severe pediatric GERD continues into adulthood Autosomal-dominant pattern with high penetrance Genetic link exacerbated by familial dietary and lifestyle habits known to worsen GERD Tomato sauces, fatty meats, fried food and caffeine Stress, sedentary, late dinners, large meal b/f exercise Interesting Associations to EERD Lifesty