Proximal pH-metry for diagnosis of upper airway complications of gastroesophageal reflux.
Otolaryngologic complications of gastroesophageal reflux (GER) are well described in adults, but this relationship has not been as carefully studied in children. We reviewed 26 dual pH-probe studies performed on 22 children with upper airway symptoms. The proximal probe was placed in the nasopharynx or hypopharynx. The distal probe was placed in the mid-proximal oesophagus. The proximal recording was considered normal if no episodes of pH < 4 were recorded. Indications for the studies were upper airway obstruction (UAO) and congenital choanal atresia (CCA). The age range was from 2 weeks to 47 months. The distal pH probe study was normal in 13 of 22 patients overall. Seventeen UAO patients had abnormal proximal pH probe studies. After treatment, 16 of 17 had improved airways. Twelve with UAO (67%) were premature and/or had developmental delay. Three CCA patients had abnormal proximal pH-probe studies and all improved after treatment. Four follow-up pH studies were normal or improved. GER-induced UAO is more frequent in infants or children with a history of prematurity or developmental delay. Proximal pH-metry is a useful technique to document the relationship between upper airway symptoms and GER. Patients with GER-induced UAO should undergo endoscopy to rule out simultaneous airway lesions.
Department of Otolaryngology and Human Communication, Medical College of Wisconsin, Milwaukee 53201, USA.
S F
SF
Conley
S L
SL
Werlin
D J
DJ
Beste
D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology* / Q000517:prevention & control; D000932:Antiemetics / Q000627:therapeutic use; D018723:Bethanechol / Q000627:therapeutic use; D002675:Child, Preschool; D002754:Choanal Atresia / Q000150:complications; D002927:Cimetidine / Q000627:therapeutic use; D004724:Endoscopy; D004947:Esophagus / Q000503:physiopathology; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D005774:Gastrostomy; D006130:Growth Disorders / Q000150:complications; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007013:Hypopharynx / Q000503:physiopathology; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008787:Metoclopramide / Q000627:therapeutic use; D009305:Nasopharynx / Q000503:physiopathology; D010277:Parasympathomimetics / Q000627:therapeutic use; D011899:Ranitidine / Q000627:therapeutic use; D012189:Retrospective Studies
D000932:Antiemetics; D006635:Histamine H2 Antagonists; D010277:Parasympathomimetics; D018723:Bethanechol; D002927:Cimetidine; D011899:Ranitidine; D008787:Metoclopramide