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Idiopathic Subglottic Stenosis and Gastroesophageal Reflux (GER)

The Chicken, the Egg, … the Enigma

47

Peterson, Kathryn A., M.D., M.Sci.; Panagiotakis, Panagiotis, M.D.; Fang, John, M.D.; Elstad, Mark, M.D.; Smith, Marshall, M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S38
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Free

Gastroenterology, University of Utah, Salt Lake City, UT; Pulmonary Medicine, University of Utah, Salt Lake City, UT and Otolaryngology, University of Utah, Salt Lake City, UT.

Purpose: Previous studies have inferred a relationship between gastroesophageal reflux (GER) and idiopathic subglottic stenosis (SGS). We propose to look at the relationship between GER and all SGS patients to determine whether the onset of SGS is directly related to GER or whether GER may be a manifestation of SGS and it's associated airway obstruction.

Methods: A retrospective chart review was perfomed on all patients seen within the University of Utah's Airway clinic between 1/2001 and 1/2005. Patient data abstracted (when available) inlcuded age, gender, symptoms of GER, EGD findings, pH probe findings, date of laser dilations, and dates of treatment with proton pump inhibitors or fundoplication. Both non-idiopathic and idiopathic patients were assessed. Univariable analysis of pH results between groups was then made. Additionally, when available frequency of dilations before and after therapy for GER were also evaluated in both groups.

Results: A total of 55 patients were identified. 27 idiopathic SGS patients and 7 non-idiopathic patients were found to have undergone dual channel pH probes. All idiopathic patients were female while 5/7 of non-idiopathic patients were female. 17/27 idiopathic SGS patients had positive pH probes as compared to 5/7 non-idiopathic SGS patients (63% vs 71%, p > .05). 8/34 (24%) SGS patients had abnormal pH detected ONLY in the proximal sensor. In those who did, only 2/8 idiopathic patients decribed having heartburn before the onset of their pulmonary symptoms. All non-idiopathic patients developed heartburn symptoms after the diagnosis of SGS. Interestingly, the frequency of dilations appeared to decrease in patients treated with PPI or fundoplication therapy.

Conclusions: Although the numbers are small, this retrospective study argues that the increased prevalence of GER in SGS is more likely related to the presence of SGS itself. There is no difference in prevalence of GER between the idiopathic and non-idiopathic SGS groups. Additionally, from those few patients who described GER, it appears that the majority of these patients developed GER after the onset of their stenosis. Interestingly, however, if the fact that the frequency of dilations for the SGS appeared to decrease after the intiation of anti-reflux therapy. This, however, needs to be further investigated in prospective studies.

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