The Edematous and Erythematous Airway Does Not Denote Pathologic Gastroesophageal Reflux

• Published in: The Journal of pediatrics Vol. 183; pp. 127 - 131
• Main Authors: Rosen, Rachel, Mitchell, Paul D., Amirault, Janine, Amin, Manali, Watters, Karen, Rahbar, Reza
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2017
• Subjects: Adolescent; Child; Child, Preschool; Chronic Disease; Cohort Studies; Cough - diagnosis; Cross-Sectional Studies; Diagnosis, Differential; Electric Impedance; endoscopy; Esophageal pH Monitoring; Esophagoscopy - methods; Female; Gastroesophageal Reflux - diagnosis; Humans; Hydrogen-Ion Concentration; impedance; Laryngeal Edema - diagnosis; Laryngoscopy - methods; Male; Observer Variation; Otolaryngology - methods; Pediatrics; Prospective Studies; reflux finding score; Risk Assessment; Severity of Illness Index; GERD; pH-MII; PPI; impedance; endoscopy; DLB; MII; reflux finding score; PedsQL; RFS; Pediatric Quality of Life Inventory; Multichannel intraluminal impedance; Direct laryngoscopy and bronchoscopy; Proton pump inhibitor; Multichannel intraluminal impedance with pH; Gastroesophageal reflux disease
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2016.11.035

To determine if the reflux finding score (RFS), a validated score for airway inflammation, correlates with gastroesophageal reflux measured by multichannel intraluminal impedance (MII) testing, endoscopy, and quality of life scores. We performed a prospective, cross-sectional cohort study of 77 children with chronic cough undergoing direct laryngoscopy and bronchoscopy, esophagogastroduodenoscopy, and MII testing with pH (pH-MII) between 2006 and 2011. Airway examinations were videotaped and reviewed by 3 blinded otolaryngologists each of whom assigned RFS to the airways. RFS were compared with the results of reflux testing (endoscopy, MII, symptom scores). An intraclass correlation coefficient was calculated for the degree of agreement between otolaryngologists' RFS. Receiver operating characteristic curves were created to determine the sensitivity of the RFS. Spearman correlation was calculated between the RFS and reflux measurements by pH-MII. The mean ± SD RFS was 12 ± 4. There was no correlation between pH-MII variables and mean RFS (|r| < 0.15). The concordance correlation coefficient for RFS between otolaryngologists was low (intraclass correlation coefficient = 0.32). Using pH-metry as a gold standard, the positive predictive value for the RFS was 29%. Using MII as the gold standard, the positive predictive value for the RFS was 40%. There was no difference in the mean RFS in patients with (12 ± 4) and without (12 ± 3) esophagitis (P = .9). There was no correlation between RFS and quality of life scores (|r| < 0.15, P > .3). The RFS cannot predict pathologic gastroesophageal reflux and an airway examination should not be used as a basis for prescribing gastroesophageal reflux therapies.