Original Contribution
The American Journal of Gastroenterology (2007) 102, 716–722; doi:10.1111/j.1572-0241.2007.01145.x
Limited Diagnostic Value of Laryngopharyngeal Lesions in Patients With Gastroesophageal Reflux During Routine Upper Gastrointestinal Endoscopy
Stephan R Vavricka MD1, Claudio A Storck MD2, Stephan M Wildi MD1, Radu Tutuian MD1, Nico Wiegand MD1, Valentin Rousson PhD3, Heiko Fruehauf MD1, Beat Mullhaupt MD1 and Michael Fried MD1
- 1Department of Internal Medicine, Division of Gastroenterology, University Hospital, Zurich, Switzerland
- 2Department of Otorhinolaryngology, University Hospital, Zurich, Switzerland
- 3Department of Biostatistics, University Hospital, Zurich, Switzerland
Correspondence: Stephan R Vavricka, MD, Department of Internal Medicine, Division of Gastroenterology, University Hospital, Raemistrasse 100, CH-8091 Zurich, Switzerland.
Received 11 July 2006; Accepted 23 September 2006.
Abstract
BACKGROUND AND AIMS: There is growing evidence that gastroesophageal reflux disease (GERD) may cause typical laryngeal/pharyngeal lesions secondary to tissue irritation. The prevalence of those lesions in GERD patients is not well established. The aim of this study was to evaluate the prevalence of GERD signs in the laryngopharyngeal area during routine upper gastrointestinal endoscopy.
METHODS:
Between July 2000 and July 2001, 1,209 patients underwent 1,311 upper gastrointestinal endoscopies and were enrolled in this study. The structured examination of the laryngopharyngeal area during upper gastrointestinal endoscopy was videotaped for review by three gastroenterologists and one otorhinolaryngologist, blinded to the endoscopic esophageal findings. From the 1,209 patients enrolled in this prospective study, all patients (group I, N = 132) with typical endoscopical esophageal findings of GERD (Savary–Miller I–IV) were selected. The sex- and age-matched control group II (N = 132) underwent upper gastrointestinal endoscopy for different reasons, had no reflux symptoms, and had normal esophagoscopy
RESULTS:
In the two groups of patients, we found no difference in the prevalence of abnormal interarytenoid bar findings (32% vs 32%), arytenoid medial wall erythema (47% vs 43%), posterior commissure changes (36% vs 34%), or posterior cricoid wall edema (1% vs 3%). The only difference was noted in the posterior pharyngeal wall cobblestoning (66% vs 50%, P = 0.004).
CONCLUSION:
The results of this large systematic investigation challenge the diagnostic specificity of laryngopharyngeal findings attributed to gastroesophageal reflux.
