Correlation of findings at direct laryngoscopy and bronchoscopy with gastroesophageal reflux disease in children: A prospective study

Objective: To correlate direct laryngoscopic and bronchoscopic findings with the presence of positive test results for gastroesophageal reflux disease (GERD) in children. Design: Prospective collection of structured data. Setting: An academic pediatric otolaryngology department. Patients: Seventy-seven consecutive patients who underwent direct laryngoscopy and bronchoscopy between June and October 1999. Interventions: During direct laryngoscopy and bronchoscopy, descriptions of 7 laryngeal and 6 cricotracheal findings were recorded on a 3-point scale (ie, absent, mild, or severe). Medical records were later reviewed to obtain results of the following tests, if they were part of the record: gastric scintiscan, 24-hour pH probe monitoring, upper gastrointestinal tract series, and esophageal biopsy. Main Outcome Measures: Correlation of mucosal abnormalities with the presence or absence of a positive test result for GERD. Results: Fifty (65%) of 77 patients had GERD diagnosed with at least 1 positive test result, 21 (27%) had no clinical symptoms and no positive GERD test results, and 5 (7%) had clinical symptoms but no positive test results. There were significant differences for total laryngeal and cricotracheal scores (P<.001) between the groups with positive and negative results. Significant differences were as follows: in the larynx - large lingual tonsil (P<.001), postglottic edema (P<.001), arytenoid edema (P<.001), ventricle obliteration (P=.03), and true vocal fold edema (P=.001), and in the cricotracheal region - general edema and erythema (P=.003) and blunting of the carina (P<.001). Severe arytenoid edema, postglottic edema, or enlargement of lingual tonsil were pathognomonic of GERD. Conclusion: Many direct laryngoscopic and bronchoscopic findings correlate well with the diagnosis of GERD as determined by using other tests.