Extraesophageal Reflux: Throat and Gastrointestinal Patients

Abstract

Objective: Diagnosis and management of EER remains controversial. We have validated a reliable Comprehensive Reflux Symptom Scale (CReSS) incorporating 34 possible symptoms of EER and gastroesophageal reflux disease (GERD). We aimed to compare CReSS in healthy volunteers, throat clinic attenders, and a heterogeneous group referred for upper gastrointestinal (GI) endoscopy. Method: The CReSS was administered to 532 participants: 103 healthy volunteers, mean age 55 years, 39% male, 15% smokers; 175 throat clinic attenders, mean age 56 years, 37% male, 11% smokers; and 254 attenders for GI endoscopy, mean age 58 years, 41% male, 14% smokers. Regular recent antacid use was recorded. Results: The mean CReSS total was 6.5 (SD 8.14) in volunteers, significantly lower (P < .001) than in throat 32.19 (SD 22.37) or GI patients 39.67 (SD 26.14). CReSS totals were independent of age. All items were endorsed by at least 17% of throat patients, 30% of GI patients. The top symptoms in throat patients were throat clearing, hoarseness, globus, and mucus (62%-82% endorsement); 48 were on regular antireflux medication, and more of this subgroup had heartburn (75%), than of those who were not (38%). Eighty-six percent of the 148 GI patients on antireflux therapy also experienced heartburn, but only 56% of the remainder. Conclusion: EER and GERD symptoms are incompletely understood and imperfectly responsive to antireflux therapy. The broad endorsement of all CReSS items by both patient groups supports recent evidence for an EER-GERD disease continuum. Back pain emerges as an under-recognized reflux symptom. Over-restrictive questionnaires reinforce speculative concepts of reflux disease.