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. 2023 Jul;48(4):501-514.
doi: 10.1111/coa.14047. Epub 2023 Mar 9.

Association between laryngopharyngeal reflux, gastroesophageal reflux and recalcitrant chronic rhinosinusitis: A systematic review

Jérôme R Lechien  1   2   3   4 , Sven Saussez  3   4 , Claire Hopkins  5
Affiliations
Free article

Association between laryngopharyngeal reflux, gastroesophageal reflux and recalcitrant chronic rhinosinusitis: A systematic review

Jérôme R Lechien et al. Clin Otolaryngol. 2023 Jul.
Free article

Abstract

Objective: To investigate the association between laryngopharyngeal reflux (LPR), gastroesophageal reflux disease (GERD) and recalcitrant chronic rhinosinusitis (CRS).

Data sources: PubMed, Cochrane Library and Scopus.

Review methods: Three investigators searched the specified databases for studies investigating the relationship between LPR, GERD and recalcitrant CRS with or without polyposis. The following outcomes were investigated with PRISMA criteria: age; gender; reflux and CRS diagnosis; association outcomes and potential treatment outcomes. The authors performed a bias analysis of papers and provided recommendations for future studies.

Results: A total of 17 studies investigated the association between reflux and recalcitrant CRS. According to pharyngeal pH monitoring, 54% of patients with recalcitrant CRS reported hypo or nasopharyngeal acid reflux events. The number of hypo- and nasopharyngeal acid reflux events was significantly higher in patients compared to healthy individuals in 4 and 2 studies, respectively. Only one study did not report intergroup differences. The proportion of GERD was significantly higher in CRS patients compared to controls, with a prevalence ranging from 32% to 91% of cases. No author considered nonacid reflux events. There was significant heterogeneity in the inclusion criteria; definition of reflux and association outcomes, limiting the ability to draw clear conclusions. Pepsin was found in sinonasal secretions more frequently in CRS patients than controls.

Conclusion: Laryngopharyngeal reflux and GERD may be contributing factors of CRS therapeutic resistance, but future studies are needed to confirm the association considering nonacid reflux events.

Keywords: head neck surgery; laryngeal; larynx; otolaryngology; rhinitis; rhino; sinusitis; voice.

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References

REFERENCES

    1. Fokkens WJ, Lund VJ, Hopkins C, Hellings PW, Kern R, Reitsma S, et al. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology. 2020;58(Suppl S29):1-464. https://doi.org/10.4193/Rhin20.600
    1. Benninger MS, Ferguson BJ, Hadley JA, Hamilos DL, Jacobs M, Kennedy DW, et al. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg. 2003;129(Suppl):S1-S32.
    1. Wahid NW, Smith R, Clark A, Salam M, Philpott CM. The socioeconomic cost of chronic rhinosinusitis study. Rhinology. 2020;58(2):112-25. https://doi.org/10.4193/Rhin19.424
    1. DelGaudio JM. Direct nasopharyngeal reflux of gastric acid is a contributing factor in refractory chronic rhinosinusitis. Laryngoscope. 2005;115(6):946-57. https://doi.org/10.1097/01.MLG.0000163751.00885.63
    1. Clarhed UKE, Johansson H, Veel Svendsen M, Toren K, Moller AK, Hellgren J. Occupational exposure and the risk of new-onset chronic rhinosinusitis - a prospective study 2013-2018. Rhinology. 2020;58(6):597-604. https://doi.org/10.4193/Rhin20.104

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