Prevalence of Gastroesophageal Reflux Disease in Patients with Extraesophageal Symptoms Referred from Otolaryngology, Allergy, and Cardiology Practices: A Prospective Study

Abstract

Aim: To investigate the prevalence of gastroesophageal reflux disease (GERD) as well as the clinical, endoscopic, and manometric characteristics in 57 adult patients with otolaryngeal symptoms, asthma, or noncardiac chest pain referred from specialized services. Methods: The following evaluations were performed: (1) upper endoscopy, (2) 24-hour ambulatory esophageal pH monitoring, and (3) esophageal manometry. The prevalence of GERD was determined, and demographic, clinical, endoscopic, and manometric characteristics of patients with or without GERD were evaluated. Results: Thirty-four out of 57 patients (60%) had GERD. The 95% confidence interval ranged from 48 to 72%. There was no statistical difference between patients with or without GERD regarding gender, age, or time of evolution of symptoms. Cough was more frequent in the subjects with GERD (75 vs. 25%, p<0.05). Nevertheless, cough was observed in only 53% of the patients with GERD. Patients suffering from laryngitis had a greater proximal and distal esophageal acid exposure time than those without. Conclusions: The prevalence of GERD was 60%. There is not a definite demographic or clinical profile that permits us to distinguish between patients with and without GERD among those with ear, nose, and throat and pulmonary symptoms or chest pain.

Estudo comparativo do pH e do volume salivar em indivíduos com laringofaringite crônica por doença do refluxo gastroesofágica antes e após o tratamento

“…The Gastroesophageal Reflux Disease is considered the most prevalent gastrointestinal disease today. Reflux-related symptoms are reported weekly by 3 to 6% of the general population [1][2][3][4][5][6][7][8][9] . Multicentric studies with large numbers of people have shown how this disease may manifest in a silent or a multisymtomatic way from the digestive stand point [7][8][9] .…”

“…It is believed that this great prevalence is due to a combination of a number of factors, from bad feeding habits and obesity 10,11 all the way down to genetic factors 9 . In the last 12 years, many investigators and clinicians have proposed an association between Gastroesophageal Reflux Disease (GERD) and chronic laryngitis, the later representing the clinical form of the disease called Laryngopharyngeal Reflux (LPR) [1][2][3][4]8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] . The larynx findings in cases of reflux laryngitis vary according to the case severity, it goes from hyperemia and mild edema of the larynx posterior third to severe cases of contact ulcers in the vocal process, exuberant scar tissue, larynx lining alterations, subglotic stenosis, even neoplastic degeneration of the epithelium 14,31,32 .…”

Proximal acid reflux treated by fundoplication predicts a good outcome for chronic cough attributable to gastro-oesophageal reflux disease

“…DeMeester scores are only validated for the distal oesophagus. The position of the proximal probe in relation to the upper oesophageal sphincter varies in different series being unstated [9,17,18] fixed 10 cm [14] or 15 cm [19] above the lower probe and 5 cm below the upper oesophageal sphincter [20]. This is important as when situated 1-2 cm below the upper oesophageal sphincter, the limit of normal is pH <4 in the upper channel, <1% of the total time [19,20] compared to pH <4 in 1.6% of the total time when sited 5 cm distal to the upper oesophageal sphincter [18].…”

“…Abnormal pH studies have been found in 50-90% of patients with asthma, many without typical reflux symptoms [1][2][3][4][5][6][7][8]. Up to 60% of patients with chronic laryngitis have abnormal proximal and/or distal oesophageal acid exposure [9], and GORD has been reported to cause up to 80% of cases of chronic hoarseness and 50% of cases of globus sensation [1]. Ten per cent of patients presenting to ear, nose and throat (ENT) clinic with hoarse voice and laryngitis have symptoms attributable to GORD; of those having 24-h pH studies, 55% has been shown to have reflux [10].…”

Estudo comparativo da concentração salivar do fator de crescimento epidérmico em indivíduos com laringite crônica por doença do refluxo gastroesofágica antes e após o tratamento: resultados preliminares

“…This supraesophageal form of the GERD was called Laryngo-Pharyngeal Reflux (LPR) by Koufman et al in 1994 7 , not aiming at establishing its origin, but rather with the intent of stressing symptoms predominance and the alterations brought about to the laryngopharyngeal segment. Symptoms associated to the reflux are weekly reported by 3 to 6% of the individuals in the general population 13,18,19 . Notwithstanding, very little is known about the physiopathology of these supraglottic GERD presentations.…”