Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2026
Pediatric Laryngopharyngeal Reflux Disease and Otitis Media With Effusion: A Systematic Review and Meta-Analysis.
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Lechien Jérôme R, Briganti Giovanni
Аннотация
OBJECTIVES: To explore the relationship between recurrent otitis media (ROM), chronic media otitis with effusion (COM), and laryngopharyngeal reflux disease (LPRD) in pediatric populations.
DATA SOURCES: PubMed, Scopus, and Cochrane databases.
REVIEW METHODS: Two investigators independently screened papers with PRISMA guidelines considering the following primary outcomes: LPRD prevalence in pediatric ROM and COM, diagnostic methods used, and detection rates of gastroduodenal markers in middle ear effusions. Two random-effects meta-analyses were performed to estimate the pooled prevalence of pepsin/pepsinogen detection in middle ear effusions and to compare pepsin concentrations between COM/ROM patients and controls using standardized mean differences (Hedges' g).
RESULTS: Twenty-eight studies were included (2070 pediatric patients). The cumulated gastroesophageal reflux disease prevalence in COM children was estimated to 50.7%, while 27.6% of children reported pharyngeal reflux events. Fifteen studies measured pepsin in effusions, reporting a pooled detection prevalence of 72.5% (95% CI: 53.7%-88.0%), rising to 85.6% with ELISA-based methods versus 17.9% with enzymatic assays. The pooled standardized mean difference in pepsin concentration between OME patients and controls was large and significant (Hedges' g = 1.92, 95% CI: 0.58-3.25, P = .005). Alkaline-activated gastroduodenal mediators were assessed in 3 studies, with detection rates ranging from 39.6% to 100% for trypsin and from 32% to 42% for bile salts. Substantial heterogeneity was found for COM/ROM and reflux disease diagnostic criteria, gastroduodenal biomarker measurements, and outcomes.
CONCLUSION: Gastroduodenal biomarkers are present in middle ear effusions of children with COM and ROM. Future prospective transversal studies exploring alkaline-activated enzymes and bile salts in effusion of children with documented pharyngeal reflux events are needed.
DATA SOURCES: PubMed, Scopus, and Cochrane databases.
REVIEW METHODS: Two investigators independently screened papers with PRISMA guidelines considering the following primary outcomes: LPRD prevalence in pediatric ROM and COM, diagnostic methods used, and detection rates of gastroduodenal markers in middle ear effusions. Two random-effects meta-analyses were performed to estimate the pooled prevalence of pepsin/pepsinogen detection in middle ear effusions and to compare pepsin concentrations between COM/ROM patients and controls using standardized mean differences (Hedges' g).
RESULTS: Twenty-eight studies were included (2070 pediatric patients). The cumulated gastroesophageal reflux disease prevalence in COM children was estimated to 50.7%, while 27.6% of children reported pharyngeal reflux events. Fifteen studies measured pepsin in effusions, reporting a pooled detection prevalence of 72.5% (95% CI: 53.7%-88.0%), rising to 85.6% with ELISA-based methods versus 17.9% with enzymatic assays. The pooled standardized mean difference in pepsin concentration between OME patients and controls was large and significant (Hedges' g = 1.92, 95% CI: 0.58-3.25, P = .005). Alkaline-activated gastroduodenal mediators were assessed in 3 studies, with detection rates ranging from 39.6% to 100% for trypsin and from 32% to 42% for bile salts. Substantial heterogeneity was found for COM/ROM and reflux disease diagnostic criteria, gastroduodenal biomarker measurements, and outcomes.
CONCLUSION: Gastroduodenal biomarkers are present in middle ear effusions of children with COM and ROM. Future prospective transversal studies exploring alkaline-activated enzymes and bile salts in effusion of children with documented pharyngeal reflux events are needed.