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Sinusitis and Gastroesophageal Reflux Disease
- John K. DiBaise, MD;
- James V. Huerter, MD; and
- Eamonn M.M. Quigley, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
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.
John K. DiBaise, MD
James V. Huerter, MD
Eamonn M.M. Quigley, MD
University of Nebraska Medical Center; Omaha, NE 68198-2000
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
