pedi-LPR-slides-070613

pedi-LPR-slides-070613 - Manifestation and Diagnosis of...

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Manifestation and Diagnosis of Pediatric Laryngopharyngeal Reflux Kevin Ho, MD Seckin Ulualp, MD University of Texas Medical Branch Dept. of Otolaryngology Grand Rounds Presentation June 13, 2007
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Up to two-thirds of infants exhibit signs of reflux (Nelson 1997) A majority of those children will outgrow their reflux by their second year of age Laryngopharyngeal reflux (LPR) has gained increasing recognition as a common pediatric disorder over the past few years . Pediatrics Reflux: Introduction Pediatrics Reflux: Introduction
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Physiologic Infrequent reflux symptoms in the absence of abnormalities Asymptomatic Rarely during sleep Often postprandial Secondary neurologic disease or esophageal dysmotility Pathologic Symptomatic GERD or LPRD Classification
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WHAT IS THE DIFFERENCE BETWEEN GERD & LPR? Gastroesophageal reflux (GER) Retrograde flow of gastric contents into the esophagus Laryngopharyngeal reflux (LPR) Extraesophageal reflux (EER) denotes the gastric contents that reaches beyond the upper esophageal sphincter (UES) into oropharynx and/or nasopharynx
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LPR vs. GER Stavroulaki. Intern J of Ped Otol 2006 LPR GER Daytime, upright Nighttime, supine < 10 % < 22 % Normal esophageal motility Esophageal dysmotility Laryngeal/ Pharyngeal symptoms Gastrointestinal symptoms, heartburn
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Upper Esophageal Sphincter Sivarao Am J Med 2000
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Pathophysiology Exact etiology unknown Direct acid and/or pepsin injury Neural-mediated laryngospasm, throat clearing, coughing
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Mucosal injury in LPR Laryngeal epithelium more susceptible to damage from refluxate than esophageal epithelium Pepsin causes depletion of laryngeal protective proteins and carbonic anhydrase Pepsin adhered to laryngeal epithelium can be activated during an acidic reflux episode Johnston N 2003, 2007
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History and Physical Stavroulaki. Intern J of Ped Otol 2006
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Carr et al. 2000 Retrospective chart review 2 groups: 214 children diagnosed with GERD 81 without GERD Significant difference in symptoms between groups: Stertor Cyanotic spells Frequent emesis Choking/ gagging Failure to thrive
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Symptoms: Infants Deal L et al. J Pedi Gastro and Nutrition 2005. EBM B
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Symptoms: Young children Deal L et al. J Pedi Gastro and Nutrition 2005. EBM B
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Chronic cough Rhinosinusitis Laryngitis Globus pharyngeus Dysphagia Airway obstruction Apnea Asthma Recurrent coup Laryngomalacia Stridor Subglottic stenosis Vocal cord nodule/ granuloma Reflux-related Otolaryngologic disorders
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