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David L. Walner, MD; Yoram Stern, MD; Mark E. Gerber, MD; Colin Rudolph, MD; Constance Y. Baldwin, BS; Robin T. Cotton, MD

Arch Otolaryngol Head Neck Surg. 1998;124:551-555.

Objectives  To determine the incidence of gastroesophageal reflux in patients with subglottic stenosis (SGS) and to determine if upper esophageal reflux occurs in addition to lower esophageal reflux in these patients.

Design  Esophageal pH probe studies were reviewed in patients diagnosed as having SGS.

Setting  A tertiary care pediatric medical center.

Patients  All patients diagnosed as having SGS between January 1990 and July 1996 who had undergone monitoring with an overnight esophageal pH probe. Seventy-four patients qualified for the study. All 74 patients underwent lower probe testing, and 55 of the 74 underwent dual (upper and lower) probe testing.

Main Outcome Measures  The percent of time a pH measurement of less than 4.0 was recorded in the upper and lower esophagus. A lower probe pH measurement of less than 4.0 more than 10% of the study time was considered high risk for developing reflux-associated pathologic symptoms. A lower probe pH measurement of less than 4.0 for 5% to 10% of the study time was considered a marginal risk for developing reflux-associated pathologic symptoms. Upper probe criteria for reflux-associated symptoms have not been established. Therefore, patients were grouped as having a pH of less than 4.0 in the upper esophagus for 0%, 0.1% to 0.9%, 1.0% to 1.9%, 2.0% to 3.0%, or more than 3% of the study time.

Results  Thirty-seven of the 74 patients who underwent lower probe testing had a pH of less than 4.0 more than 5% of the study time, and 24 had a pH of less than 4.0 more than 10% of the study time. Twelve of the 55 patients who underwent upper probe testing had no measurable reflux; 27 of the 55 had a pH of less than 4.0 more than 1% of the study time; 14 had a pH of less than 4.0 more than 2% of the study time, and 11 had a pH of less than 4.0 more than 3% of the study time.

Conclusions  Gastroesophageal reflux is frequently present in patients with SGS. Gastric contents frequently reach the upper and lower esophagus in these patients. In addition, the high incidence of gastroesophageal reflux in these patients suggests that it may play a role in the development of SGS. The possible effect of gastroesophageal reflux on the surgical repair of SGS requires further study.

From the Department of Pediatric Otolaryngology and Maxillofacial Surgery (Drs Walner, Stern, Gerber, Baldwin, and Cotton, and Ms Baldwin) and the Division of Pediatric Gastroenterology and Nutrition (Dr Rudolph), Children's Hospital Medical Center, Cincinnati, Ohio. Dr Walner is now with the Department of Otolaryngology/ Bronchoesophagology, Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill.

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