Gastroesophageal reflux disease and vocal disturbances

Abstract

CONTEXT: Gastroesophageal reflux disease is a chronic disease in which gastroduodenal contents reflux into the esophagus. The clinical picture of gastroesophageal reflux disease is usually composed by heartburn and regurgitation (typical manifestations). Atypical manifestations (vocal disturbances and asthma) may also be complaint. OBJECTIVE: To analyse the clinical, endoscopic, manometric and pHmetric aspects of patients suffering from gastroesophageal reflux disease associated with vocal disturbances. METHODS: Fifty patients with gastroesophageal reflux disease were studied, including 25 with vocal disturbances (group 1 - G1) and 25 without these symptoms (group 2 - G2). All patients were submitted to endoscopy, manometry and esophageal pHmetry (2 probes). The group 1 patients were submitted to videolaryngoscopy. RESULTS: Endoscopic findings: non-erosive reflux disease was observed in 95% of G1 patients and 88% of G2. Videolaryngoscopy: vocal fold congestion, asymmetry, nodules and polyps were observed in G1 patients. Manometric findings: pressure in the lower esophageal sphincter (mm Hg): 11.6 ± 5.2 in G1 and 14.0 ± 6.2 in G2 (P = 0.14); pressure in the upper esophageal sphincter (mm Hg): 58.4 ± 15.9 in G1 and 69.5 ± 30.7 in the controls. pHmetric findings: De Meester index: 34.0 ± 20.9 in G1 and 15.4 ± 9.4 in G2 (P<0.001); number of reflux episodes in distal probe: 43.0 ± 20.4 in G1 and 26.4 ± 17.2 in G2 (P = 0.003); percentage of time with esophageal pH value lower than 4 units (distal sensor): 9.0% ± 6.4% in G1 and 3.4% ± 2.1% in G2 (P<0.001); number of reflux episodes in proximal probe: 7.5 ± 10.9 in G1 and 5.3 ± 5.7 in G2 (P = 0.38); percentage of time with esophageal pH values lower than 4 units (Proximal probe): 1.2 ± 2.7 in G1 and 0.5 ± 0.7 in G2 (P = 0.21). CONCLUSIONS: 1) The clinical, endoscopic, and manometric findings observed in patients with vocal disturbance do not differ from those without these symptoms; 2) gastroesophageal reflux intensity is higher in patients with vocal disturbance; 3) patients without vocal disturbance can also present reflux episodes in the proximal probe.

Association between laryngopharyngeal reflux and benign vocal folds lesions: A systematic review.

“…Counting articles across several categories when appropriate, 32 of these articles are related to nodules, 29 to polyps, 18 to cysts, 32 to Reinke's edema, and 10 to sulcus vocalis. When filtered through the inclusion and exclusion criteria, a total of 35 articles were kept for analysis: 16 are related to nodules, 5,7,[17][18][19][20][21][22][23][24][25][26][27][28][29][30] eight to polyps, 7,20,[22][23][24]26,31,32 three to cysts, 18,20,30 five to Reinke's edema, 22,24,26,33,34 and three to sulcus vocalis 7,18,35 (Fig. 1).…”

“…The 28 remaining studies based LPR diagnosis on symptoms AE findings, with a few authors using validated clinical tools. 18,21,32 LPR laryngoscopic findings were not taken into consideration for diagnosis in eight studies, 5,19,20,22,23,27,30,31 and only one author assessed exam findings in a blinded fashion 33 (Table I). Two authors utilized gastroesophageal reflux disease (GERD) criteria for LPR diagnosis.…”

“…7,28 As for exclusion criteria, only three authors excluded confounding conditions that may lead to misdiagnosis of reflux. 7,21,23 Some authors included smokers (N = 5), 18,22,30,31,33 patients with excess alcohol consumption (N = 3), 18,30,33 or patients with chronic rhinosinusitis (N = 2). 7,31 No study excluded patients with allergies.…”

“…The literature search identified 32 relevant publications; among these, 16 met our inclusion criteria (Table II). Four and five studies have, respectively, suggested the coexistence of suspected LPR and nodules in patients with nonspecific laryngopharyngeal symptoms 21,23,25,27 and in voice professionals (i.e., singers and teachers) 7,18,25,28,30 without exhibiting reliable LPR diagnostic methods. One study stated that nodules and LPR-related symptoms were more prevalent in elderly patients than younger subjects.…”

“…These studies exhibited a low level of evidence in the demonstration of an association between LPR and polyps. 7,20,23,31,32 However, similar to nodules, it was reported that LPR negatively Epidemiological analysis was performed using the Tool to Assess Risk of Bias in Cohort Studies. 16 For the diagnostic of reflux, the following criteria were used for the bias assessment: No = not defined; Probably no = diagnostic based on suspected symptoms AE signs; Probably yes = diagnostic based on symptoms and signs according to clinical validated tools.…”