Abstracts
1998 Digestive Disease Week

#964

RESPIRATORY AND PHARYNGEAL SYMPTOMS: A COMMON MANIFESTATION IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE. Kauer WKH, Balint A, Stein HJ, Feu_ner H, Siewert JR Department of Surgery, Technical University, Munich, Germany.

Gastroesophageal reflux disease is believed to be a common and often underestimated etiologic factor in patients suffering from respiratory and/or pharyngeal symptoms. By utilizing dual pH monitoring in the distal and proximal esophagus we investigated the manifestation of gastroesophageal reflux disease in patients with respiratory, pharyngeal and/or globus symptoms.

Between 6/96 and 10/97 40 patients with respiratory, pharyngeal and/or globus symptoms underwent long-term dual pH monitoring with one pH probe placed 5 cm above the lower esophageal sphincter and a second one placed 5 cm below the upper esophageal sphincter. In addition upper endoscopy and stationary manometry were performed in all patients. 22 patients (55%) complained about respiratory and/or pharyngeal symptoms such as cough, hoarseness or asthma. 12 patients (30%) complained additionally about a globus sensation and 6 patients (15%) complained about globus alone. Patients with a primary pulmonary or ENT disease had been excluded.

In the distal esophagus pH monitoring showed an increased exposure to gastric juice in 10 patients (45%) with respiratory and/or pharyngeal symptoms, in 6 patients (50%) with additional globus and in 3 patients (50%) with globus alone. Corresponding exposure to gastric juice in the proximal esophagus could be shown in 80% (n=8) of the patients with respiratory and/or pharyngeal symptoms, in 83% (n=5) of the patients with additional globus and in 0% (n=0) of the patients with globus alone. All but 2 patients (85%) with reflux in the proximal esophagus showed disorders of their esophageal body motility. Complete control of the respiratory and/or pharyngeal symptoms could be achieved in all but one patient (92%) by medical treatment with omeprazol (n=8) or antireflux surgery (n=4).

Gastroesophageal reflux is a common cause for secondary respiratory and/or pharyngeal symptoms. Dual pH monitoring with a second pH probe placed in the proximal esophagus is a feasible and well tolerated method to detect the presence of gastric juice in the proximal esophagus. A sufficient antireflux therapy can control these secondary symptoms in the majority of patients. There seems to be no correlation between the presence of gastroesophageal reflux and the symptom of globus sensation.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.