title: Multilevel esophageal biopsy in children with airway manifestations of extraesophageal reflux disease.
abstract: OBJECTIVE
  Extraesophageal reflux disease (EERD) is a recognized cause of upper airway symptoms in children. Direct microlaryngoscopy and bronchoscopy (MLB) is performed for diagnostic information as to the extent and severity of the inflammation caused by gastric refluxate. Esophagoscopy with multilevel biopsy performed at the time of MLB may provide the clinician with additional information to assist in the management of EERD. We undertook to determine the role of multilevel esophageal biopsy in children who have airway manifestations secondary to EERD.
  
  
  METHODS
  We performed a retrospective chart review of 139 esophagoscopies with multilevel biopsy done at the time of MLB by a single provider for evaluation of symptoms highly associated with EERD at a tertiary care children's hospital. The histopathologic presence of esophagitis was analyzed by site and compared to the presence and location of tracheolaryngeal abnormalities.
  
  
  RESULTS
  Tracheolaryngeal abnormalities associated with EERD were found in 97% of patients when evaluated by MLB. Concomitant esophagitis was found in 59% of these patients. Of patients who had 0, 1, 2, 3, 4, or 5 positive findings on MLB, 75% (3 of 4), 58% (7 of 12), 57% (20 of 35), 62% (32 of 51), 56% (18 of 32), and 80% (4 of 5), respectively, had at least 1 positive biopsy.
  
  
  CONCLUSIONS
  We found that EERD that affects the pediatric upper airway was associated with esophagitis in more than half of the patients. The usefulness of 4-level biopsies during esophagoscopy and concomitant airway endoscopy will be discussed.
authors.affiliation: Department of Otolaryngology, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, New York, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Mitzner
authors.forename: Linda
authors.initials: L
authors.lastname: Brodsky
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004942:Esophagitis, Peptic / Q000473:pathology*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007223:Infant; D007819:Laryngeal Edema / Q000473:pathology; D007827:Laryngitis / Q000473:pathology*; D007829:Laryngostenosis / Q000473:pathology; D007830:Larynx / Q000473:pathology*; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology; D012189:Retrospective Studies; D014132:Trachea / Q000473:pathology*; D014135:Tracheal Stenosis / Q000473:pathology; D014136:Tracheitis / Q000473:pathology*