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Evidence of extraesophageal reflux in idiopathic subglottic stenosis. Laryngoscope 2011 Jun;121(6):1266-73

Date

05/11/2011

Pubmed ID

21557240

DOI

10.1002/lary.21776

Scopus ID

2-s2.0-79958258640   49 Citations

Abstract

OBJECTIVES/HYPOTHESIS: Idiopathic subglottic stenosis (iSGS) is a disease predominantly of females that, by definition, has no known etiology. Collagen-vascular disease, localized trauma, extraesophageal reflux (EER), and hormonal alterations have all been postulated as potential etiologies of iSGS. It is hypothesized that iSGS is a reflux mediated disease and that evidence of EER exists in affected patients.

STUDY DESIGN: Case-control study.

METHODS: Patients with iSGS were identified prospectively over a 2.5-year period (2007-2010). During their endoscopic management, biopsies of the subglottic scar and postcricoid area were evaluated for the presence of pepsin, an indicator of exposure to gastric refluxate. Control patients had similar biopsies while undergoing operative management for disease unrelated to reflux. Charts of both patients and controls were reviewed for clinical history of reflux, pH-metry, and laboratory testing for collagen-vascular disease.

RESULTS: Twenty-two patients with iSGS were treated. All patients were female. No patient had serology positive for collagen-vascular disease. Thirteen (59%) patients with iSGS had pepsin present in their larynx or trachea. Control patients did not have detectable pepsin in their tissue (P = .041). Dual probe 24-hour pH studies were performed in 10 (45%) patients. These studies were positive for EER in seven patients but this did not statistically correlate to the presence of pepsin in their tissue (P = 1.0).

CONCLUSIONS: iSGS is a disease almost exclusively of women. EER is implicated in the development of iSGS. Pepsin is detectable in the subglottic scar and larynges of patients with iSGS. Standard pH-metry may be inadequate in predicting degree of EER in patients with iSGS.

Author List

Blumin JH, Johnston N

Authors

Joel H. Blumin MD Chief, Professor in the Otolaryngology department at Medical College of Wisconsin
Nikki Johnston PhD Associate Professor in the Otolaryngology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Blotting, Western
Case-Control Studies
Electrophoresis, Polyacrylamide Gel
Female
Gastroesophageal Reflux
Humans
Laryngostenosis
Larynx
Middle Aged
Mucous Membrane
Pepsin A
Polyps
Trachea
Vocal Cord Paralysis
jenkins-FCD Prod-480 9a4deaf152b0b06dd18151814fff2e18f6c05280