Is there evidence of extraesophageal reflux (EER) in idiopathic subglottic stenosis (iSGS)?
Background: Although a subset is related to identifiable trauma, many stenoses in the upper airway are deemed idiopathic. Theories involving the etiology of iSGS have centered around two possibilities: that an occult condition leads to mucosal scarring of the cricotracheal junction and that it relates to a female gender predilection. Proposed causes have included collagen-vascular disease, hormonal alteration, occult trauma and EER. However, studies have ruled out causes such as Wegener’s granulomatosis and hormonal alteration. Interest in EER has continued as the significance of EER to inflammatory lesions of the upper aerodigestive tract has been established. Pepsin assay has been used to identify evidence of gastric refluxate and as a reliable marker for EER.
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June 2011Study Design: Case-control study.
Setting: Division of Laryngology and Professional Voice, Department of Otolaryngology and Communications Sciences, Medical College of Wisconsin, Milwaukee, Wis.
Synopsis: Patients with iSGS were identified prospectively over a 2.5-year period and were evaluated for the presence of pepsin using biopsies. Control patients had similar biopsies while undergoing operative management for disease unrelated to reflux. Charts of both patient groups were reviewed for clinical history of reflux, pH-metry and laboratory testing for collagen-vascular disease. Of 22 patients with iSGS, all were female and none had collagen-vascular disease. Pepsin was present in 13 (59 percent) iSGS patients, but control individuals had no detectable pepsin. Dual probe 24-hour pH studies were performed in 10 (45 percent) patients and were positive for EER in seven patients, but this did not correlate to the presence of pepsin in their tissue. The researchers had difficulty obtaining an age- and gender-matched series of control biopsies of both the posterior commissure and the subglottis, so statistics presented were potentially underpowered and subject to error.
Bottom Line: Evidence of nonacidic EER is present in the affected tissue of those with iSGS and may be causative of iSGS. While 24-hour pH-metry identifies those with acidic reflux, it does not predict the presence of pepsin and nonacidic reflux.
Citation: Blumin JH, Johnston N. Evidence of extraesophageal reflux in idiopathic subglottic stenosis. Laryngoscope. 2011;121:1266-1273.
—Reviewed by Sue Pondrom