Laryngospasm: An atypical manifestation of severe gastroesophageal reflux disease (GERD)

Objectives: To present a potentially life-threatening manifestation of gast roesophageal reflux disease (GERD), laryngospasm. This review covers the di agnosis and management of eight patients treated by the authors. Study Desi gn: A retrospective analysis of 8 consecutive patients who were referred fo r the evaluation of unexplained laryngospasm. The medical therapy and lifes tyle modifications of treatment are discussed. Methods: The patient records were reviewed and tabulated for age, onset of symptoms, and history of GER D; the presence of an associated upper respiratory infection with persisten t cough; and the development of syncope in the presence of laryngospasm. Re sults: All 8 patients had initial control of laryngospasm. Three had comple te control without relapse, 3 had initial control with rare relapse of mild laryngospasm, and 2 patients had initial control with frequent relapses. S ix of the 8 had syncopal episodes as a consequence of the laryngospasm. All patients were initially treated with a proton pump inhibitor. Five of the 8 required the addition of an esophageal prokinetic agent to control the re flux and subsequent laryngospasm. Two patients are off all medications at t he time of this writing and 4 of the 8 have had rare relapses after initial control of symptoms. Once control of the laryngospasm had been achieved, t here were no subsequent episodes of syncope. Conclusions: Based on the data collected in these 8 individuals, patients with reflux disease (known or u nknown) can develop severe laryngospasm and possible syncope. The key facto r seems to be the association of a recent or concurrent upper respiratory i nfection that results in a protracted cough that is more severe when supine and at times violent. The cough increases the amount of the refluxate, whi ch is the noxious insult to the larynx. Key Words: GERD, laryngospasm, sync ope.