pedi-LPR-070613.doc

TITLE: Manifestation and Diagnosis of Pediatric Laryngopharyngeal RefluxSOURCE: Grand Rounds Presentation, UTMB, Dept. of OtolaryngologyDATE: June 13, 2007RESIDENT PHYSICIAN: Kevin Ho, M.D.FACULTY PHYSICIAN: Seckin Ulualp, M.D.SERIES EDITORS: Francis B. Quinn, Jr., MD This material was prepared by resident physicians in partial fulfillment of educational requirements established for the Postgraduate Training Program of the UTMB Department of Otolaryngology/Head and Neck Surgery and was not intended for clinical use in its present form. It was prepared for the purpose of stimulating group discussion in a conference setting. No warranties, either express or implied, are made with respect to its accuracy, completeness, or timeliness. The material does not necessarily reflect the current or past opinions of members of the UTMB faculty and should not be used for purposes of diagnosis or treatment without consulting appropriate literature sources and informed professional opinion. Introduction: Gastroesophageal reflux (GER) is a common physiologic condition in children; larygopharyngeal reflux (LPR) has gained increasing recognition over the past few years as a distinct pediatric condition. The former refers to retrograde flow gastric content into the esophagus, while the refluxate passes through the upper esophageal sphincter to reach the pharynx in the latter condition. Clinical Manifestation: Although the prevalence of LPR in children is not known, it is estimated that up to 10% of adult patients present to otolaryngologists with symptoms related to reflux. It occurs more commonly in the upright position and during daytime. Unlike GER, esophageal motility is thought to be normal in LPR. Laryngeal and pharyngeal symptoms are more common in LPR than GER, which tends to present with heartburn and/or abdominal complaints. Symptoms of LPR are non-specific, thus making accurate diagnosis difficult. Infants may present with vomiting, regurgitation, failure to th