Background
An association between chronic rhinosinusitis (CRS) and gastroesophageal reflux disease (GERD) has been previously reported; however, the underlying factors linking CRS and GERD remain to be elucidated.
Objective
To assess the association of GERD and CRS using prospective and retrospective approaches.
Methods
The retrospective study comprised a large cohort of CRS cases, whereas the prospective arm evaluated a series of CRS cases and controls.
Results
In the retrospective arm of the study, of the 1066 patients with CRS, 112 (10.5%) had GERD. Among patients with CRS, GERD was associated with higher body mass index, older age, and female sex. The odds ratios (ORs) for asthma and allergic rhinitis in the CRS group with GERD compared with the CRS group without GERD were 2.89 (95% confidence interval [CI], 1.905–4.389) and 2.021 (95% CI, 1.035–3.947). Furthermore, GERD was associated with a greater duration of CRS. Ninety patients with CRS and 81 controls were enrolled in the prospective arm of the study. In the CRS group, GERD was associated with asthma (OR, 4.77; 95% CI, 1.27–18.01). Patients with CRS and GERD had a longer duration and a younger age at onset of CRS. In controls, no association was found between GERD and asthma (OR, 0.67; 95% CI, 0.09–5.19) or allergic rhinitis (OR, 0.35; 95% CI, 0.05–2.59).
Conclusion
Patients with CRS and GERD are more likely to have atopic conditions and asthma when compared with patients with CRS but without GERD. One of the potential explanations of this link is that comorbid GERD and atopic disease are potential risk factors for development of CRS.
RATIONALE: Chronic rhinosinusitis (CRS) is a burdensome and prevalent inflammatory disease of upper airways whose pathophysiology is driven by host-environment interaction. However, associations of community and environmental factors with CRS transition states have not been previously examined. METHODS: We mailed a CRS symptom questionnaire to 23,700 primary care patients in Pennsylvania and 6-month follow-up questionnaire to 7801 responders. We defined CRS based on European Position Paper on Rhinosinusitis (EPOS) epidemiologic criteria. We characterized transition states of CRS: persistent CRS if met EPOS criteria for CRS at both time points and non-persistent CRS if met criteria only at baseline; incident CRS if had no history at baseline but met criteria at follow-up and never CRS if never met criteria. We evaluated associations of distance to minor and major roadways (in quartiles), residential greenness index, community type and urbanicity. We performed multivariate survey logistic regression controlling for age, sex, race/ethnicity, Medical Assistance and tobacco use. RESULTS: There were 4966 responders at follow-up; 558 had persistent CRS, and 83 incident CRS. The fourth quartile of distance to minor roads was associated with reduced odds of persistent CRS compared to nonpersistent CRS, OR 5 0.38; 95% CI 5 0.17-0.81 and there was a trend of decreasing odds across all four quartiles (p < 0.01). Similar association was seen for incident CRS versus never CRS for the third quartile of distance. CONCLUSIONS: Patients residing the farthest from minor roads had a reduced risk of persistent CRS. Residential greenness, major roadways, and urbanicity were not associated with transitions.
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