Possible relationship of gastroesophagopharyngeal acid reflux with pathogenesis of chronic sinusitis

Gastroesophagopharyngeal reflux (GEPR) has been suggested as a cause of ped iatric sinusitis. However its contribution to the pathogenesis of chronic s inusitis in adults has not been systematically investigated. We evaluated t he prevalence of GEPR in II CT confirmed chronic sinusitis patients (51 +/- 4 years) who had not responded to conventional therapy, and II normal heal thy controls (44 +/- 7 years). A 3-site ambulatory esophagopharyngeal pH mo nitoring technique (probe location: 2 cm proximal, 3-4 cm distal to UES and 5 cm proximal to LES high pressure zones) was used. A pharyngeal pH drop w as accepted as a true reflux event only if it was coincident with or preced ed by esophageal pH declines of a similar or larger magnitude. Studies were performed while subjects were on a uniform 2500 calorie diet (provided). R esults: Ambulatory pH monitoring documented GEPR in seven of II patients (1 -12 episodes) and two of 11 normal volunteers (1,2 episodes) (p < 0.05). A total of 34 nonbelch related pharyngeal acid reflux events were identified in patients, but none was associated with coughing. In both groups, all pha ryngeal acid events occurred in the upright position. Compared to normal co ntrols prevalence of pharyngeal reflux of gastric acid is significantly hig her inpatients with chronic sinusitis unresponsive to conventional therapy and suggests a different esophagopharyngeal distribution pattern of gastric refluxate in this patient group; these findings suggest that GEPR may cont ribute to the pathogenesis of chronic sinusitis in some adult patients.