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Question 1 Does anti-reflux therapy improve symptoms in infants with laryngomalacia?
  1. John R Apps1,
  2. Julia D Flint2,
  3. Ian Wacogne3
  1. 1Molecular Haematology and Cancer Biology Unit, Institute of Child Health, London, UK
  2. 2Department of Clinical Pharmacology, University College London Hospitals NHS Trust, London, UK
  3. 3General Paediatrics Department, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
  1. Correspondence to John R Apps, Molecular Haematology and Cancer Biology Unit, Institute of Child Health, Guilford Street, London WC1N 1EH, UK; John.apps{at}doctors.net.uk

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Scenario

A 3-month-old infant is referred to the general paediatric clinic with stridor. You think this is likely to be due to laryngomalacia but for further reassurance you ask a colleague in ENT to assess the infant. As part of his assessment, the ENT doctor starts the infant on anti-reflux therapy, with the explanation that there is an association between reflux and laryngomalacia. You wonder if this is true, and whether anti-reflux medicine is actually helpful.

Structured clinical question

In infants with stridor secondary to laryngomalacia [population] does treatment with anti-reflux therapy [intervention] lead to an improvement in symptoms [outcome]?

Search strategy

Secondary sources

No appropriate reviews were found in The Cochrane Library.

Primary sources

PubMed was searched in July 2011 using the search terms Gastroesophageal reflux/Gastro-oesophageal reflux/GERD/GORD/GER/GOR AND Laryngomalacia or Stridor, and combinations of the terms laryngomalacia, stridor, reflux, antireflux, proton pump inhibitor, histamine antagonists, domperidone, prokinetic and cisapride. Bibliographical searches were also undertaken.

Search outcome

Thirteen case series or reports were identified in electronic sources, and a search of a bibliography revealed one further report of two cases.1 Five papers were excluded, four as stridor was grouped with other respiratory presentations and one as it investigated gastro-oesophageal reflux in recurrent croup. Adult papers and non-English language papers were excluded. Nine studies were included (table 1). …

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