Oropharyngeal dysphagia presents with difficulty feeding, noisy breathing, arching, discomfort with feeding and growth issues. For years, these symptoms were felt to be related to gastroesophageal reflux disease but with the growth of aerodigestive centers nationwide, novel data suggests that these patients are aspiraing during swallowing and GERD is rarely the primary driver of symptoms. We will review the symptoms of oropharyngeal dysphagia relative to GERD. We will review the diagnostic testing options for these patients including the strengths and limitations of clinical feeding evaluations in infants and the high rate of silent aspiration in children. We will review the therapies for GERD and oropharyngeal dysphagia including the potential harms to treating for GERD when the diagnosis is oropharyngeal dysphagia. Finally, we will review the natural history of both GERD and oropharyngeal dysphagia and the implications for feeding and growth.
Rachel Rosen, MD, MPH is an Associate Professor of Pediatrics at Harvard Medical School and the Director of the Aerodigestive Center at Boston Children’s Hospital. She is a pediatric gastroenterologist who cares for children with motility disorders who may have associated respiratory symptoms and feeding difficulties. Her research interests include the impact of gastroesophageal reflux and esophageal dysmotility on the lungs.