Tu1622 Evaluation of Relationship Between Gastroesophageal Reflux Disease (GERD) and Laryngopharyngeal Reflux Disease (LPRD)

Evaluation of Relationship Between Gastroesophageal Reflux Disease (GERD) and Laryngopharyngeal Reflux Disease (LPRD) Yoshihiro Kondo*, Makoto Sasaki, Naotaka Ogasawara, Yasushi Funaki, Mari Mizuno, Akihito Iida, Naohiko Kawamura, Kentaro Tokudome, Yasutaka Hijikata, Shinya Izawa, Ryuta Masui, Yoshitsugi Ito, Yasuhiro Tamura, Hisatsugu Noda, Kunio Kasugai Gastroenterology, Aichi Medical University, Nagakute, Japan Introduction: Gastroesophageal reflux disease (GERD) is defined as a condition that develops when reflux of the stomach contents involving gastric acid juice causes troublesome symptoms. GERD typically presents heartburn and regurgitation, but it can also present atypically as chronic cough, throat pain, and asthma. Atypical symptoms such as chronic cough, throat pain, and asthma are considered to be associated with laryngopharyngeal reflux disease (LPRD). Currently, LPRD is associated with laryngeal irritation such as laryngitis caused by reflux of the gastric acid juice. However, the accurate relationship between GERD, especially endoscopic positive esophagitis (EE) and LPRD is still unknown. In this study, we examined the grades of EE and the larynx findings using esophago-gastroendoscopy, and investigated the relationship between GERD and LPRD. Methods: Four hundred two patients except gastrointestinal malignant tumors, gastrointestinal ulcer, esophageal varices, and usage of proton pump inhibitor or H2-blocker underwent esophago-gastroendoscopy for examining the findings of gastro-esophageal junction, cardiac position of the stomach, and larynx at the Department of Gastroenterology, Aichi Medical University School of Medicine between January 2007 and December 2008. Three otorhinolaryngologists and three gastroendoscopists blindly evaluated the findings of laryngopharyngeal area (edema of inferior position of larynx, redness of aryepiglottic fold, thickness of interarytenoid mucosa, and presence of vocal fold granuloma) and gastro-esophageal junction, respectively. Independent and significant predictive factors of EE (background of patients, symptoms, the laryngopharyngeal findings, presence of esophageal hernia) were determined by multivariate analysis. Results: Thirty patients (7.5%) were diagnosed as EE. Of all patients, 114 (28.4%), 230 (57.2%), 271 (67.4%), and 7 (1.7%) patients harbored edema of inferior position of larynx, reddness of aryepiglottic fold, thickness of interarytenoid mucosa, and granuloma of vocal fold, respectively. One hundred fifteen patients (28.6%) complained of laryngopharyngeal reflux symptoms, but there was no relationship between laryngopharyngeal reflux symptoms, the grades of EE, and the findings of larynx. However, esophageal hernia [odds ratio (OR), 2.6], and thickness of interarytenoid mucosa (OR, 4.9), were independent predictive factors of EE. Conclusion: Although laryngopharyngeal reflux symptoms possessed no statistical relation to the findings of both EE and laryngitis, the thickness of interarytenoid mucosa which might be initially affected by the reflux of stomach contents involving gastric acid juice was exceedingly related to EE.