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Pediatric Otolaryngology

(113) Correlation of GERD and Allergy with Recurrent Croup Airway Pathology

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time
Has Audio

    Presenting Author(s)

  • Neil Rowlands, BA

    Medical Student, MS3
    Ohio University Heritage College of Osteopathic Medicine
    Dublin, Ohio, United States

    • Co-Author(s)

  • KL

    Kevin Liu, MD

    Clinical Research Fellow
    Department of Pediatric Otolaryngology, Nationwide Children's Hospital
    Columbus, Ohio, United States

  • CB

    Charles Bradshaw, BS

    The Ohio State University School of Medicine, USA

    • Senior Author(s)

  • Prasanth Pattisapu, MD, MPH

    Assistant Professor
    Nationwide Childrens Hospital
    Columbus, Ohio, United States

  • TC

    Tendy Chiang, MD

    Assistant Professor
    Nationwide Children's Hospital
    Columbus, Ohio, USA

  • Charles A. Elmaraghy, MD

    Chief Department of Pediatric Otolaryngology, Associate Professor
    Department of Otolaryngology, Nationwide Children's Hospital
    New Albany, OH, USA

Disclosure(s):
Neil Rowlands, BA: No relevant relationships to disclose.
Prasanth Pattisapu, MD, MPH: No relevant relationships to disclose.


Introduction: Bronchoscopy is the gold standard of lower airway evaluation in patients with recurrent croup; however structural pathology is rarely diagnosed. The objective of this study was to report on the incidence of structural abnormalities on bronchoscopy and assess whether prophylactic acid suppression or negative environmental allergy testing were associated with anatomic pathology in patients experiencing recurrent croup episodes.

Methods: An institutional review board-approved retrospective cohort study of patients presenting with croup to a single tertiary care center between 2016 and 2021 was conducted. Inclusion criteria consisted of patients age < 18 years who presented to the emergency department, urgent care, or otolaryngology office with recurrent croup (ICD9-464.4 or ICD10-J05.0 and having symptoms at least twice in a year) and underwent bronchoscopy. Demographic features, abnormal findings on first bronchoscopy, allergy testing results, GERD prophylaxis, and active croup concurrent with GERD intervention were noted. Abnormal findings on bronchoscopy included subglottic stenosis, tracheomalacia, and bronchomalacia.

Results: Among 168 patients with recurrent croup who underwent bronchoscopy, median age was 2.8 years (IQR 1.70-4.8) and 71.4% (n=120) of the cohort were males. Of these patients, 31.5% (n=53) had pathologic findings, most commonly tracheomalacia (11.3%), followed by subglottic stenosis (8.9%), and bronchomalacia (4.2%). Of those that received GERD prophylaxis during a croup episode (n=64, 38.1%) or with previous allergy testing (n=58, 34.5%), 39.0% and 29.3% had structural pathology respectively. Univariable logistic regression was used to analyze the relationship between negative allergy testing (P=0.612, OR 1.36, 95% CI 0.42-4.39) or history of GERD prophylaxis (P=0.209, OR 0.53, 95% CI 0.20-1.42) and abnormal bronchoscopy findings.

Conclusions: Neither GERD nor a history of allergies reduces the likelihood of abnormal bronchoscopy findings in patients with recurrent croup, but multi-institutional research is necessary for broad generalization.