Does a neural reflex exist that links the esophagus and the nasal airway, possibly explaining a mechanism for the association between gastroesophageal reflux (GER) disease and chronic rhinosinusitis (CRS)?
Background: Many studies have shown an association between GER and CRS. The leading theory on the pathogenic mechanism is direct reflux of gastric acid into the proximal airway, leading to mucosal injury. This association has been demonstrated in both pediatric and adult populations, using esophageal and nasopharyngeal pH testing.
Study design: Prospective study
Setting: Department of Surgery-Otolaryngology, Head and Neck Surgery, Adelaide University, Australia
Synopsis: Ten healthy volunteers with no history of CRS or GER and negative radioallergosorbent (RAST)testing underwent distal esophageal stimulation with saline and hydrochloric acid (HCl), with baseline and post-stimulation measurements of nasal symptoms score, peak inspiratory flow rate and mucus production. All nasal parameters increased (negative impact) with both saline and HCl. The changes were greater with HCl than with saline, but the difference was not statistically significant. The increase in nasal parameters indicates that distal esophageal stimulation, even non-acidic, causes a reflex change in nasal physiology.
This study had a very small patient population. A larger number of patients might have allowed the differences in response between saline and HCl to reach statistical significance.
Bottom line: Stimulation of the distal esophagus appears to cause a transient change in the physiology of the nasal mucosa. This change may indicate the presence of an esophageal-nasal reflex, which could contribute to the etiology of CRS.
Citation: Wong IW, Rees G, Greiff L, et al. Gastroesophageal reflux disease and chronic sinusitis: in search of an esophageal-nasal reflex. Am J Rhinol Allergy. 2010;24(4):255-259.
—Reviewed by John Del Gaudio, MD