Childhood gastroesophageal reflux disease with laryngopharyngeal reflux and association of psychosocial risk factors

Abstract

Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are inflammatory sequelae following the backflow of stomach contents to the esophagus or larynx/pharynx, respectively, the latter most often occurring in GERD. Unlike adults, the clinical parameters of “reflux symptom index” and “reflux finding score” are not routinely done in children suspected of LPR associated with GERD. Proton-pump inhibitor (PPI) trial with a 50% reduction of symptom severity following 2–4 weeks of empirical PPI, which is then continued for 12 weeks, is considered a valuable diagnostic and therapeutic tool for GERD in children. We present our successful management of an 8-year-old child, who had primarily respiratory symptoms with no associated respiratory, cardiac, or neurological etiology. Clinical evidence of underlying LPR secondary to GERD was confirmed by otolaryngologists with Reflux Finding Score. Significant psychosocial risk factors observed during her evaluation were addressed by psychologists. PPI therapy and behavioral therapy were initiated and the child improved drastically. The association of significant psychological issues in family and the social context appears to be significant in childhood GERD. A multidisciplinary comprehensive clinical approach is the cornerstone for its successful medical management.