Abstract
The goal of this study was to assess whether mucosal sensitivity is related to different combinations of symptoms and lesions in laryngopharyngeal reflux (LPR) and erosive esophagitis and to determine whether reflux pattern is important in the development of the symptoms and lesions of gastroesophageal reflux disease (GERD) or LPR. We conducted a prospective study of 55 unselected new patients: 27 erosive esophagitis patients and 28 LPR patients. The erosive esophagitis group had a significantly higher rate of Bernstein test positivity than the LPR group. The proportions of patients with pathologic acid reflux at the proximal and distal probe were similar in the erosive esophagitis group and in the LPR group. These results were inconsistent with the endoscopic findings. Both retrosternal heartburn and regurgitation symptoms were higher in erosive esophagitis patients. The paucity of classical GERD symptoms and lesions in LPR patients could be attributable to mucosal insensitivity but not to reflux pattern.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Locke GR, Talley NJ, Fett SJ, et al. (1997) Prevalence and clinical spectrum of gastroesophageal reflux: a population based study in Olmsted County, Minnesota. Gastroenterology 112:1448–1456
Ormseth EJ, Wong RKH (1999) Reflux laryngitis: pathophysiology, diagnosis and management. Am J Gastroenterol 94(10):2812–2817
Kaufman JA, Wiener GJ, Wallace CW, et al. (1988) Reflux laryngitis and its sequela: the diagnostic role of ambulatory 24 hour monitoring. J Voice 2:78–79
Delahunty JE, Cherry J (1968) Experimentally produced vocal cord granulomas. Laryngscope 78:1941–1947
Morrison MD, Nichol H, Rammage LA (1988) Diagnostic criteria in functional dysphonia. Laryngscope 94:1–8
Jindal JR, Milbrath MM, Hogan WJ, et al. (1994) Gastroesophageal disease as a likely cause of “idiopathic” subglottic stenosis. Am Otol Rhinol Laryngol 103:186–191
Bortolotti M (1989) Laryngospasm and reflex central apnea caused by aspiration of refluxed gastric contents in adults. Gut 30:233–238
Kaufman JA (1991) The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 255 patients using ambulatory 24 hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngscope 101(Suppl 53):1–78
Kaufman J, Sataloff RT, Toohill R (1996) Laryngopharyngeal reflux: consensus report. J Voice 10:215–216
Hewson EG, Sinclair JW, Dalton CB, et al. (1989) Acid perfusion test: does it have a role in the assessment of noncardiac chest pain? Gut 30:305–310
Belafsky PC, Postma GN, Koufman JA (2002) Validity and reliability of the reflux symptom index (RSI). J Voice 16:274–277
Belafsky PC, Postma GN, Koufman JA (2001) Validity and reliability of the reflux finding score (RFS). Laryngoscope 111:1313–1317
Ossakow SJ, Elta G, Colturi T, et al. (1987) Esophageal reflux and dysmotility as the basis for persistent cervical symptoms. Ann Otol Rhinol Laryngol 96:387–392
Orlando RC (1998) Review article: oesophageal mucosal resistance. Aliment Pharmacol Ther 95:903–912
Ho KY, Kang JY (2000) Esophageal mucosal acid sensitivity can coexist with normal pH recording in healthy adult volunteers. J Gastroenterol 35:261–264
Behar J, Biancani P, Sheahan DJ (1976) Evaluation of esophageal tests in the diagnosis of reflux esophagitis. Gastroenterology 71:9–15
Tobey NA, Carson JL, Alkiek RA, et al. (1996) Dilated intercellular spaces: a morphological feature of acid reflux–damaged human esophageal epithelium. Gastroenterology 111:1200–1205
Carlsson R, Fandriks L, Jonsson C, et al. (1999) Is the esophageal squamous epithelial barrier function impaired in patients with gastroesophageal reflux disease? Scand J Gastroenterol 34:454–458
Richter JE, Johns DN, Wu WC, et al. (1985) Are esophageal motility abnormalities produced during the intraesophageal acid perfusion test? JAMA 253:1914–1917
Burns TW, Venturates SG (1985) Esophageal motor function and response to acid perfusion in patients with symptomatic reflux esophagitis. Dig Dis Sci 30:529–535
Jung B, Steinbach J, Beaumont BS, et al. (2004) Lack of association between esophageal acid sensitivity detected by prolonged pH monitoring and Bernstein testing. Am J Gastroenterol 99:410–415
Takeda T, Lui J, Gui A (2001) Heartburn, not chest pain, is the most common symptom in response to esophageal distension in normal subjects. Gastroenterology 120:222 (1167A)
Fass R, Naliboff B, Higa L, et al. (1998) Different effect of long term esophageal acid exposure on mechanosensitivity and chemosensitivity in humans. Gastroenterology 115:1363–1373
Pehlivanov N, Liu J, Mittal RK (2001) Sustained esophageal contraction: a motor correlate of heartburn symptom. Am J Physiol Gastrointest Liver Physiol 281:G743–G751
Clouse RE, McCord GS, Lustman PJ, et al. (1991) Clinical correlates of abnormal sensitivity to intraesophageal balloon distension. Dig Dis Sci 36:1040–1045
Trimble KC, Pyrde A, Heading R (1995) Lowered oesophageal sensory thresholds in patients with symptomatic but not excess gastro-oesophageal reflux: evidence for a spectrum of visceral sensitivity in GORD. Gut 37:7–12
Aziz Q, Thompson DG (1998) Brain-gut axis in health and disease. Gastroenterology 115:1353–1362
Paterson WG, Selucky M, Hynna-Liepert TT (1991) Effect of intra-esophageal location and muscarinic blockade on balloon distension-induced chest pain. Dig Dis Sci 36:282–288
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Korkmaz, M., Tarhan, E., Unal, H. et al. Esophageal Mucosal Sensitivity: Possible Links with Clinical Presentations in Patients with Erosive Esophagitis and Laryngopharyngeal Reflux. Dig Dis Sci 52, 451–456 (2007). https://doi.org/10.1007/s10620-006-9514-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-006-9514-5