For Infants with Swallowing Troubles, Treatment of Gastroesophageal Reflux Disease May Help

A new study from the University of Chicago establishes that Gastroesophageal Reflux Disease (GERD) may contribute to pediatric swallowing dysfunction. The study further suggests that GERD treatment may improve the swallowing function in distress.

Infant swallowing is a highly coordinated process. In order for an infant to swallow, intact sensorimotor reflexes must be integrated at the brainstem level. Any changes in this sequence can lead to difficulty in feeding and swallowing which may ultimately lead to aspiration. If an infant experiences swallowing problems and they are untreated, then the child is at risk for malnutrition, dehydration, and respiratory problems.

There are a variety of causes for infant swallowing problems including GERD. GERD is extremely common, affecting some 5-8 percent of the pediatric population. GERD is defined as a backflow of acid from the stomach into the swallowing tube or esophagus. Common symptoms of GERD include vomiting, regurgitation, pain and excessive crying or constant fussiness. Symptoms can range from mild to life-threatening.

The relationship between GERD, microaspiration, and respiratory diseases is an accepted and frequently described scenario in medical literature. Despite this, the scientific study of such changes, by which a neurologically-intact larynx, which should protect the lower airway, can allow microaspiration to occur, is rarely discussed.

A new study attempts to address that relationship in the study, "Improved Infant Swallowing after GERD Treatment: A Function of Improved Laryngeal Sensation?" The authors are Dana L. Suskind MD, Penny Huddleston M.A., CCC-SLP, Fuad M. Baroody MD, and Donald C. Liu MD PhD all from the University of Chicago; Dana M. Thompson MD from the Division of Pediatric Otolaryngology, Mayo Clinic and Mayo Eugenio Litta Children's Hospital; and Martha Gulati MD with the Department of Preventive Medicine and Cardiology, Northwestern University. Their findings will be presented at the 21st annual meeting of the American Society of Pediatric Otolaryngology, being held May 20-22, 2006, at the Hyatt Regency Hotel in Chicago, IL.

Methodology: The authors hypothesized that laryngopharyngeal reflux (LPR) has a negative impact on laryngopharyngeal sensation with resulting microaspiration/penetration in infants and children, and that reflux treatment will have a positive impact on swallowing function in these patients. A review of 28 patient records (21 males, seven females) neurologically-intact infants and children (e.g. no evidence of cerebral palsy, seizures, etc.), ranging in age from one to thirty-two months, from two different tertiary-care children's hospitals with evidence of gross as well as micro-aspiration, swallowing dysfunction, and LPR, was made. Each child underwent either medical or surgical intervention for control of their GERD. The patients had their swallow function and laryngeal sensitivity evaluated before and after treatment of gastroesophageal reflux.