Gastro Esophageal Reflux Clinical Trial
Official title:
Does Gastric Reflux Induce Sinonasal Symptoms?
The study is conducted to:
- study correlation between sinonasal troubles & GERD
- Assess whether antireflux therapy improve state of sinus in patients complaining from
reflux & sinonasal symptoms
Gatroesophageal reflux disease(GERD) is one of the most common diagnoses made by both primary
care physicians and gastroenterologists . It is defined as a gastrointestinal motility
disorder that results from the reflux of stomach contents into the esophagus or oral cavity,
causing symptoms or complications .The prevalence of GERD is estimated to be between 20 and
30% of adults in western countries.
Some studies have found a correlation between GERD and certain diseases of the airway and a
proposed association to others. Both asthma and laryngitis can be caused by GERD. Pepsin has
been discovered in the middle ear of children with middle ear effusion and GERD has been
implicated in the pathophysiology of otitis media with effusion. The authors conclude that
there may be a role of antireflux therapy in patients with otitis media with effusion. The
relationship between reflux and snoring/obstructive sleep apnea syndrome (OSAS) has been
studied, and it is known that OSAS patients have a high incidence of nocturnal
gatroesophageal reflux (nGER).
The coexistence of reflux and various respiratory disorders can be used to argue that there
is probably a correlation between reflux and CRS. Though some data indicate an association
between GERD and upper airway inflammatory disease, this remains a matter of controversy in
today's medicine. It is suggested that, if an upper or lower respiratory tract disorder is
causally related to GERD, certain criteria should be met:
1. An increased coexistence of both disorders should exist compared to the general
population.
2. A biologically plausible pathophysological mechanism should explain how GERD can cause
CRS.
3. clinical manifestations of the suspected GERD-related CRS should respond to anti-reflux
therapy.
There are Some theories for the relation between gastric reflux and CRS. The first one is the
direct exposure of the nasal and nasopharyngeal mucosa to gastric acid causing inflammation
of the mucosa and impaired mucociliary clearance which could cause obstruction of sinus ostia
and recurrent infections. It is known that pH variations affect ciliary motility and
morphology in the respiratory mucosa.The second hypothesis is a relationship mediated by the
vagus nerve; a mechanism already proven in the lower airway and in the nasal mucosa of
patients with rhinitis but not in patients with CRS.
Dysfunction of the autonomic nervous system can lead to reflex sinonasal swelling and
inflammation, and consequent blockage of the ostia. Demonstrated that by infusing saline with
hydrochloric acid in the lower esophagus of healthy volunteers, there was increased
production of nasal mucus, increased score of nasal symptoms, and reduced peak nasal
inspiratory flow.
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