pedi-LPR-slides-070613.pptVIP

Manifestation and Diagnosis of Pediatric Laryngopharyngeal Reflux Kevin Ho, MD Seckin Ulualp, MD University of Texas Medical Branch Dept. of Otolaryngology Grand Rounds Presentation June 13, 2007 LPR vs. GER Upper Esophageal Sphincter Pathophysiology Exact etiology unknown Direct acid and/or pepsin injury Neural-mediated laryngospasm, throat clearing, coughing Mucosal injury in LPR Laryngeal epithelium more susceptible to damage from refluxate than esophageal epithelium Pepsin causes depletion of laryngeal protective proteins and carbonic anhydrase Pepsin adhered to laryngeal epithelium can be activated during an acidic reflux episode History and Physical Carr et al. 2000 Retrospective chart review 2 groups: 214 children diagnosed with GERD 81 without GERD Significant difference in symptoms between groups: Stertor Cyanotic spells Frequent emesis Choking/ gagging Failure to thrive Symptoms: Infants Symptoms: Young children Otitis Media Nasopharyngeal inflammation causing Eustachian tube dysfunction Crapko 2007 Prospective non-randomized Middle ear effusion collected after myringotomy for OME children Pepsin detected in ~ 60% samples pH: 6-7.6 (pepsin inactive) Barium Esophagram Used mainly if suspect anatomical abnormalities: Achalacia, web, stricture Sensitivity: 20-60% Specificity: 64-90% Positive predictive value: 80-82% Limitation: High false negative rate due to short sampling period Nuclear Scintigraphy Oral ingestion of technetium-labeled food Also detects aspiration, non-acidic reflux, and gastric emptying Sensitivity: 15- 59% Specificity: 83- 100% Limitations: Only measure initial postprandial period Lack of standardized techniques Lack of normative data Direct Laryngoscopy and Bronchoscopy Limited data in Pediatric population Carr MM 2001 Prospective non-RCT Indications for DLB: Trach surveillance, persistent stridor, dysphonia, etc. 77 children, 50 (65%) GERD +ve based on: pH monitoring Barium esophagram Scintiscan Esophageal biopsy Ca