Treatment of Extraesophageal Reflux Disease

Extraesophageal reflux (EER) is a sequelae of gastroesophageal reflux (GER) with varying manifestations including oropharyngeal (dysphagia; feeding difficulties; dental erosions), upper airway (laryngitis; rhinosinusitis), lower airway (chronic cough; asthma; recurrent pneumonia), and cardiac disease (chest pain). Managing a patient with EER begins with making an accurate diagnosis and the approaches to management overlap with those of GER, including lifestyle, pharmacologic, and surgical treatments. Thickeners, proton pump inhibitors (PPIs), and prokinetics are among the most common, whereas more novel treatments involve pepsin inhibition and GABA agonism. Surgical treatments, such as Nissen fundoplication or intrapyloric Botox injection, are sometimes helpful but continue to be second- and third-line options, particularly in pediatrics. Overall, robust research regarding the management of EER in children is lacking, and the approach must be individualized by considering the age of the patient, predominant symptoms, and harms of therapy. Reassessment of response to therapy is also important, as EER remains diagnostically challenging and a wider differential must be considered when there is little to no response to conventional therapies. Future investigations in children are necessary to establish effective therapies and a reliable algorithm for our approach to pediatric EER.