RESEARCH - GERD, EER, and recurrent chronic rhinosinusitis

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Eur Arch Otorhinolaryngol. 2006 Mar 9; [Epub ahead of print]

Gastroesophageal reflux disease (GERD), extraesophageal reflux (EER) and

recurrent chronic rhinosinusitis.

Jecker P, Orloff LA, Wohlfeil M, Mann WJ.

Department of Otolaryngology, Mainz Medical School, 55101, Mainz, Germany,

peter.jecker@....

Chronic polypoid rhinosinusitis (CRS) is a common disease, affecting

approximately 16% of the adult population in the US every year. In addition

to many well known predisposing factors, an association with reflux disease

is hypothesized. Such an association might explain the recurrence of

polyposis in the face of improved surgical techniques and postsurgical

treatment of CRS. At present it is unclear whether extraesophageal reflux

directly injures the sinus mucosa, whether gastroesophageal reflux leads to

vagus-mediated neuroinflammatory changes, or whether both mechanisms occur

separately or simultaneously. In patients suffering from recurrent CRS

(n=20) and healthy volunteers (n=20), ambulatory 24 h two channel pH testing

was performed. The number of reflux events, the fraction of the total time

during which pH was below 4, and the reflux area index (RAI) were determined

in the esophagus as well as in the hypopharynx. Patients with recurrent CRS

had significantly more reflux events in the esophagus and the fraction of

pH<4 and the RAI were increased up to 10-fold compared to healthy

volunteers. In contrast to the esophagus, these differences were not

observed in the hypopharynx. Recurrent CRS is often associated with GERD but

not with EER. Recurrent disease or prolonged recovery after surgery should

raise the suspicion of reflux disease as a possible triggering factor.

Because GERD itself cannot be diagnosed by laryngoscopy, and because of the

subjectivity of symptoms such as heartburn, the otolaryngologist should

consider double-probe pH testing as the diagnostic procedure of choice.

PMID: 16525820

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16525820

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