Chronic sinusitis that is refractory to medical and surgical therapy presents a considerable clinical challenge. An association between gastroesophageal reflux disease (GERD) and chronic sinusitis has been suggested [1-3]. We reviewed the clinical presentation, diagnostic evaluation, and treatment of patients with chronic refractory sinusitis referred for evaluation of GERD.

Nineteen patients (11 women; mean age, 50.2 years [range, 16 to 76 years]) were evaluated (Table 1). Eighteen had previously undergone sinus surgery. Thirteen (68%) described classic GERD symptoms, and 14 (74%) had possible "atypical" GERD symptoms. On endoscopy (n = 8), 1 patient had erosive esophagitis and 3 had microscopic evidence of GERD. On esophageal manometry (n = 16), the median lower esophageal sphincter pressure was 7.9 mm Hg; 11 patients (69%) had a hypotensive sphincter (<10 mm Hg). All patients except for the patient with erosive esophagitis underwent 24-hour esophageal pH testing by using a single-channel (n = 7) or dual-channel (n = 11; electrodes 15 cm apart) pH catheter. Fourteen patients (78%) had abnormal results (pH < 4.0 more than 9.2% of total time at the distal site or more than 3.3% of total time at the proximal site [4]).

Twelve patients were treated with a proton-pump inhibitor, 4 received a proton-pump inhibitor plus a prokinetic agent, and 2 underwent laparoscopic fundoplication. At a mean follow-up of 5.8 months (range, 1 week to 12 months), 12 patients (67%) noted improvement in sinus symptoms; 4 of these patients reported dramatic improvement. Dramatic improvement was confined to patients with an abnormal pH result.

We provide, for the first time, results of both the diagnostic evaluation and therapy for GERD in patients with chronic sinusitis. Classic symptoms and objective evidence of GERD were common. The high prevalence of both conditions and referral bias make it difficult to determine whether this association is causal or incidental; the favorable response of refractory sinusitis symptoms to GERD therapy suggests that it is causal. Confirmation must await evidence of improvement in objective findings of sinusitis and longer follow-up in a larger patient sample.