Gastropharyngeal and gastroesophageal reflux in globus and hoarseness.

BACKGROUND The role of gastropharyngeal reflux in patients with globus pharyngeus and hoarseness remains unclear. OBJECTIVE To evaluate patients with complaints of globus, hoarseness, or globus and hoarseness combined for the presence of gastropharyngeal and gastroesophageal reflux. DESIGN Prospective clinical cohort study of 3 groups of patients undergoing ambulatory 24-hour double-probe pH monitoring. In patients with pathologic gastroesophageal reflux, an upper gastrointestinal endoscopy was also performed. SETTING Tertiary care, outpatient clinic. PATIENTS Twenty-seven patients with globus alone, 20 patients with hoarseness alone, and 25 patients with globus and hoarseness combined. RESULTS Patients with well-defined pathologic reflux (ie, gastroesophageal reflux with or without gastropharyngeal reflux) were present mainly in the group of patients with globus combined with hoarseness: 18 (72%) of 25 patients, compared with 7 (35%) of 20 patients with hoarseness alone and 8 (30%) of 27 with globus alone. Seven (10%) of all 72 patients had prolonged acid exposure at the laryngopharyngeal junction in the presence of a normal gastroesophageal pH registration. Abnormal findings in the esophagus were found at endoscopy in 17 (65%) of 26 patients with pathologic gastroesophageal reflux (with or without gastropharyngeal reflux). CONCLUSIONS We found a high prevalence of pathologic reflux in patients with both globus and hoarseness. Based on these findings, we strongly advise upper gastrointestinal endoscopy for symptomatic otolaryngological patients with pathologic gastroesophageal reflux.

[1]  P. Devriese,et al.  Ambulatory pH Measurements at the Upper Esophageal Sphincter , 1998, The Laryngoscope.

[2]  R. Toohill,et al.  Role of refluxed acid in pathogenesis of laryngeal disorders. , 1997, The American journal of medicine.

[3]  C. Andrew van Hasselt,et al.  Gastroesophageal Reflux, Motility Disorders, and Psychological Profiles in the Etiology of Globus Pharyngis , 1997, The Laryngoscope.

[4]  J. Koufman,et al.  Laryngopharyngeal reflux: consensus conference report. , 1996, Journal of voice : official journal of the Voice Foundation.

[5]  A. Curran,et al.  A prospective study of acid reflux and globus pharyngeus using a modified symptom index. , 1995, Clinical otolaryngology and allied sciences.

[6]  R. Shaker,et al.  Esophagopharyngeal distribution of refluxed gastric acid in patients with reflux laryngitis. , 1995, Gastroenterology.

[7]  L. Brudin,et al.  Gastroesophageal reflux disease and laryngeal symptoms. Is there really a causal relationship? , 1994, ORL; journal for oto-rhino-laryngology and its related specialties.

[8]  J. Koufman The Otolaryngologic Manifestations of Gastroesophageal Reflux Disease (GERD): A Clinical Investigation of 225 Patients Using Ambulatory 24‐Hour pH Monitoring and an Experimental Investigation of the Role of Acid and Pepsin in the Development of Laryngeal Injury , 1991, The Laryngoscope.

[9]  P. Katz,et al.  Ambulatory esophageal and hypopharyngeal pH monitoring in patients with hoarseness. , 1990, The American journal of gastroenterology.

[10]  J. Koufman,et al.  Chronic hoarseness secondary to gastroesophageal reflux disease: documentation with 24-h ambulatory pH monitoring. , 1989, The American journal of gastroenterology.

[11]  P. Allan,et al.  Pharyngoesophageal dysmotility in globus sensation. , 1989, Archives of otolaryngology--head & neck surgery.

[12]  J. Wilson,et al.  Gastroesophageal Reflux and Posterior Laryngitis , 1989, The Annals of otology, rhinology, and laryngology.

[13]  E. Gaynor Gastroesophageal reflux as an etiologic factor in laryngeal complications of intubation , 1988, The Laryngoscope.

[14]  W. dodds,et al.  Acid neutralizing capacity of human saliva. , 1982, Gastroenterology.

[15]  A. Freeland,et al.  Globus hystericus and reflux oesophagitis , 1974, The Journal of Laryngology & Otology.

[16]  I. Mair,et al.  Aetiological aspects of the globus symptom , 1974, The Journal of Laryngology & Otology.

[17]  M. Donner,et al.  Pharyngeal Localization of Symptoms of Gastroesophageal Reflux , 1970, The Annals of otology, rhinology, and laryngology.

[18]  G. Ardran,et al.  Globus hystericus—A manifestation of reflux oesophagitis? , 1970, The Journal of Laryngology & Otology.

[19]  K. Malcomson Radiological findings in globus hystericus. , 1966, The British journal of radiology.