GASTROESOPHAGEAL REFLUX IN PATIENTS WITH SUBGLOTTIC STENOSIS

Objectives: To determine the incidence of gastroesophageal reflux in p atients with subglottic stenosis (SGS) and to determine if upper esoph ageal reflux occurs in addition to lower esophageal reflux in these pa tients. Design: Esophageal pH probe studies were reviewed in patients diagnosed as having SGS. Setting: A tertiary care pediatric medical ce nter. Patients: All patients diagnosed as having SGS between January 1 990 and July 1996 who had undergone monitoring with an overnight esoph ageal pH probe. Seventy-four patients qualified for the study. All 74 patients underwent lower probe testing, and 55 of the 74 underwent dua l (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 an d 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 ref lux-associated pathologic symptoms. A lower probe pH measurement of le ss 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. Th erefore, 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 m ore than 3% of the study time. Results: Thirty-seven of the 74 patient s who underwent lower probe testing had a pH of less than 4.0 more tha n 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 prob e 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 frequen tly present in patients with SGS. Gastric contents frequently reach th e upper and lower esophagus in these patients. In addition, the high i ncidence of gastroesophageal reflux in these patients suggests that it may play a role in the development of SGS. The possible effect of gas troesophageal reflux on the surgical repair of SGS requires further st udy.