Abstract â–¡ 168

Gastroesophageal reflux (GER) has been implicated in the pathophysiology of sudden infant death syndrome (SIDS) and apparent life-threatening events (ALTE). It is also a significant factor leading to laryngeal inflammation and airway compromise. Defining parameters that correlate with laryngeal complications of GER has been difficult. This study investigated the relationship between findings of upper and lower esophageal dual pH probe monitoring, histopathologic changes in laryngeal and esophageal biopsy specimen, and microlaryngoscopic visualization of the larynx in asymptomatic children prior to airway reconstruction surgery.

Thirty-nine patients were enrolled in the study, with an average age of 3.5 (range 0.5 - 11 years). None of the children had overt symptoms directly attributable to classic GER (recurrent emesis, chest pain, hematemesis, recurrent pneumonia). There was weak correlation of a positive upper pH probe and positive histology of the post-cricoid biopsy area (p=0.06). There was weak correlation of a positive microlaryngoscopy evaluation and pathologic histologic changes of the post-cricoid biopsy area using Kendall-Tau B correlation coefficients.

Eosinophilia of the laryngeal mucosa, similar to that seen in esophagitis secondary to GER, has been identified on laryngeal biopsies. The association of this pathologic finding with an abnormal upper pH probe study suggests this diagnostic modality will be useful in the diagnosis of laryngeal mucosa injury secondary to GER. Children with ALTE may benefit from dual pH probe studies and laryngeal biopsies to determine the potential role of GER induced laryngeal inflammation in the etiology of the apneic event.