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Vol 6, No 1 (2004)
Published online: 2004-03-16

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Laryngological aspects of the gastroesophageal reflux in children

Ireneusz Bielecki, Jolanta Mniszek, Halina Woś
Chirurgia Polska 2004;6(1):51-63.

Abstract

The gastroesophageal reflux (GER) belongs to a group of common infancy disorders and occurs at an average rate of 1 per 500 births, more often in boys than in girls. Special attention should be paid to children from the high risk group (bronchopulmonary dysplasia, tracheoesphageal fistula, follow-up of the esophageal atresia repair, flaccidity of the larynx, interposition of the colon, neurological disturbances), in whom the GER may co-exist with the primary disease and may increase the risk of the occurrence of life-threatening respiratory complications. Reflux disease (GERD) may take the form of the so-called «laryngological mask». The patients in this group less often show gastrological symptoms such as chronic hoarseness, cough, laryngeal stridor and apnea in infants, laryngitis, recurring pneumonia and even recurring otitis media, as well as nausea, heartburn or swallowing disorders. Cough lingering for more than 3 weeks is usually considered to be an extraesophageal symptom of GER.
The most valuable diagnostic method for determining GER is 24-hour esophageal pH monitoring. An X-ray examination with a contrast medium of the upper part of the alimentary tract is not very helpful in the process of GER diagnosis. However, it is useful in detecting anatomical defects. A scintigraphic examination of the esophagus is carried out in cases of alkaline or neutral reflux that may be a result of pH changes caused by milk or increased sialorrhea. An endoscopy of the esophagus enables the detection of pathological changes in the mucous membrane and makes it possible to carry out a biopsy. The occurrence of respiratory complaints necessitates the execution of endoscopy of the larynx, trachea and bronchi. The most common picture of the mucous membrane of the airways being chemically destroyed is the so-called «cobble stones» membrane.
The GERD treatment process is divided into three stages: 1) change of life style; 2) pharmacological treatment; 3) surgical treatment.
The change of life style consists mainly of the modification of the diet: more frequent and at the same time smaller meals, adoption of hypoallergenic and thicker food, elevation of the bed-head and positioning of sleeping infants on the left side. The pharmacological treatment relies on the use of proton pump inhibitors (PPI), antagonists of H2 receptors (cymetidine, ranitidine, famotidine), as well as pro-kinetic and cytoprotective (antacida) drugs. Postoperative treatment is administered in children in whom clinical symptoms persist despite conservative therapy. The most common method is Nissen’s fundoplication.

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Chirurgia Polska (Polish Surgery)