Twenty-four-hour esophageal pH monitoring in children and adolescents with chronic and/or recurrent rhinosinusitis

Abstract

Gastroesophageal reflux (GER) disorder was studied in children and adolescents with chronic and/or recurrent rhinosinusitis not associated with bronchial asthma. Ten children with a clinical and radiological diagnosis of chronic and/or recurrent rhinosinusitis, consecutively attended at the Pediatric Otolaryngology Outpatient Clinic, Federal University of São Paulo, were evaluated. Prolonged esophageal pH monitoring was used to investigate GER disorder. The mean age of the ten patients evaluated (eight males) was 7.4 ± 2.4 years. Two patients presented vomiting as a clinical manifestation and one patient presented retrosternal pain with a burning sensation. Twenty-four-hour esophageal pH monitoring was performed using the Sandhill apparatus. An antimony probe electrode was placed in the lower third of the esophagus, confirmed by fluoroscopy and later by a chest X-ray. The parameters analyzed by esophageal pH monitoring included: total percent time of the presence of acid esophageal pH, i.e., pH below 4 (<4.2%); total number of acid episodes (<50 episodes); number of reflux episodes longer than 5 min (3 or less), and duration of the longest reflux episode (<9.2 min). One patient (1/10, 10%) presented a 24-h esophageal pH profile compatible with GER disorder. This data suggest that an association between chronic rhinosinusitis not associated with bronchial asthma and GER disorder may exist in children and adolescents, especially in those with compatible GER disorder symptoms. In these cases, 24-h esophageal pH monitoring should be performed before indicating surgery, since the present data suggest that 10% of chronic rhinosinusitis surgeries can be eliminated.

Gastroesophageal reflux and chronic rhinosinusitis

“…Some studies investigating the association between reflux and CRS have only used distal oesophageal measurements to confirm a diagnosis of gastroesophageal reflux, and therefore do not help to elucidate the mechanism by which GERD is associated with CRS [4,5]. Acidity can be assessed in the distal oesophagus, in the hypopharynx, and in the nasopharynx.…”

Association of gastro-oesophageal reflux and chronic rhinosinusitis: systematic review and meta-analysis

“…Eighteen excluded publications were case series, studying CRS response to GORD treatment (8)(9)(10)(11)(12)(13)(14) , GORD pathogenesis in CRS (8,12,13,(15)(16)(17)(18)(19) , and epidemiological association between GORD and CRS (20)(21)(22)(23)(24)(25) .…”

IPEG Guidelines for the Surgical Treatment of Pediatric Gastroesophageal Reflux Disease (GERD)

“…3 Esophageal pH monitoring gives information about the number of episodes of reflux with a pH less than 4, as well as total time exposure to a pH less than 4 and the length of the episodes. 1,6,7 Gastric emptying studies (radionuclide-labeled 99m Tc sulfur colloid liquid or semisolid food) can assess for gastric emptying and has been used for the measurement of reflux. Scintigraphy can measure both acid and nonacid reflux.…”