Review article: extra-oesophageal reflux disease in children

In children, respiratory and ENT disorders are associated with extra-oesophageal reflux. These include asthma, recurrent pneumonia, cough, apnoea, sinusitis, otitis media, laryngomalacia, recurrent croup and recurrent respiratory papillomatosis. The traditional tests of barium swallow, 24 h pH probing have limited ability to proving causality between the gastro-oesophageal reflux and the extra-oesophageal symptoms. Multichannel oesophageal impedance measurements have now been studied in children and when combined with pH monitoring will like become the gold standard investigation. It is also important but difficult to determine if the refluxate is entering the lung and while it has recently been shown that the lipid laden macrophage index obtained from bronchoalveolar lavage (BAL) lacks specificity detecting pepsin in BAL is both sensitive and specific for pulmonary aspiration. Children with GER who have failed medical therapy are commonly referred for antireflux surgery. There is a paucity of well-controlled prospective data on the efficacy of fundoplication in children. The long-term results of antireflux surgery are mixed. Those children with isolated lower oesophageal sphincter incompetence can be expected to do well while those with dysmotility, such as neurologically impaired children, and those with reflux-related respiratory disease have a high rate of symptom recurrence.