Association of Pediatric Gastroesophageal Reflux Disease and Subglottic Stenosis: A Systematic Review and Meta-analysis

Gastroesophageal reflux disease in children, which affects approximately 18% of infants, results from gastric contents flowing into the esophagus due to factors such as immature sphincter function. Regurgitation is normal and often resolves by age two; however, persistent gastroesophageal reflux disease can lead to otolaryngological lesions such as subglottic stenosis. PubMed, AIRE, Scholar, MEDLINE, Springer Nature Journal, and Scopus were searched from their inception to February 2024. Pediatric patients < 18 years diagnosed with subglottic stenosis and investigated for gastroesophageal reflux disease or related endoscopic findings were included. Studies not reporting relevant outcomes, duplicates, and non-English studies were excluded. Six studies conducted between 1990 and 2001 explored gastroesophageal reflux-associated otolaryngological issues among pediatrics. Among the 149 participants with subglottic stenosis, 53.47% had laryngopharyngeal reflux disease. Some studies used the Cotton-Myer classification to identify intubation and gastroesophageal reflux disease as primary causes. Younger age and difficulty with intubation were associated with subglottic stenosis severity. Early management of gastroesophageal reflux disease before surgical intervention improved outcomes and reduced endoscopic repair failure rates. A meta-analysis of risk ratios from three studies underscored the relationship's statistical significance, with an overall effect size of 0.03 (95%CI: 0.01 to 0.17) and a P-value < .0001. Heterogeneity analysis showed minimal variability across studies, supporting the observed association between gastroesophageal reflux disease and subglottic stenosis. The prevalence of gastroesophageal reflux disease in pediatric subglottic stenosis cases has been established, stressing the need for early diagnosis and treatment to minimize the necessity of surgery.