Is there evidence to link acid reflux with chronic sinusitis or any nasal symptoms? A review of the evidence

Abstract

BACKGROUND: Acid reflux into the oesophagus, larynx, pharynx or nasopharynx has been suggested as a causal factor in chronic rhino-sinusitis (CRS), which can then be refractory to nasal treatments. The aim of this review was to conclude on the strength of the link between GORD, LPR, nasopharyngeal reflux, nasal symptoms and CRS. METHOD: Medline and Embase search. RESULTS: Nineteen papers describing varying studies on CRS, GORD, LPR and PPI therapy were found. Four adult case-controlled studies showed more acid reflux events/symptoms in refractory CRS patients. Paediatric cohort studies showed more reflux events in rhinosinusitis patients than the general paediatric population, but they are not conclusive. Many papers do not use robust CRS diagnostic criteria for inclusion into studies and take no confounding factors into consideration. CONCLUSION: The evidence of a link is poor with no good randomised controlled trials available. The few adult studies that show any link between acid reflux and nasal symptoms are small case-controlled studies with moderate levels of potential bias. There is not enough evidence to consider anti-reflux therapy for adult refractory CRS and there is no evidence that acid reflux is a significant causal factor in CRS.

Relation between chronic rhinosinusitis and gastroesophageal reflux in adults: systematic review

“…More importantly, previous review studies failed to show a clear evidence-based relationship between CRS and GERD 19 , 20 in adults. Since these reviews were published at least four years ago, our objective was a new systematic review on the topic, to gather all the current evidence published around this issue, and to evaluate the quality and relevance of the interaction between GERD and CRS in adults.…”

Rhinosinusitis: evidence and experience

“…Although studies conducted between 1997 and 2006 have observed a significant association between the two diseases, 50 a recent systematic review found a weak association between acid reflux, nasal symptoms, and ARS. 51 …”

Dietary habits, physical activity, and self-reported rhinosinusitis in children and adolescents

“…In our study we did not find correlation between GORD and pediatric chronic RS. Several reviews also did not reveal such association (54)(55)(56). In our study none of children and adolescents were active smokers.…”