Idiopathic Subglottic tracheal stenosis due to Gastroesophageal Reflux: Still a challenge

Abstract

Objective: Idiopathic subglottic stenosis (ISS) represents a spectrum of disease with an unclear underlying pathophysiology and a significant challenge for clinical management. Several studies have implicated a potential role of gastroesophageal reflux disease (GERD). The leading hypothesis is that reflux of gastric contents into the upper airway contributes to the development of ISS. We present a case of ISS due to GERD successfully treated endoscopically. Material: A 32 year old female was urgently admitted to our department due to dyspnea on exertion. She presented with cough, wheezing, stridor and difficulty clearing secretions. Apparently, she had this pattern of symptoms over months including vomiting and symptoms of GERD never correctly treated. No previous intubation was described. The patient underwent CT scan and virtual bronchoscopy. Both revealed a stenosis exactly below the vocal cords. The bronchoscope nearly passed through the stenosis and a scar tissue and inflammation were detected in the affected area. A short course of steroids was given for 24 hours. Results: We proceeded with endoscopic resection through bronchoscopy by using electrocautery and cryotherapy. A repeated procedure took place 15 days later followed by long-term adjuvant medical therapy (Anti-reflux, antibacterial, and inhaled corticosteroid) and relief of symptoms. Conclusion: In cases of ISS where GERD is a potential causative factor, resection by endoscopy may be the treatment of choice. Once GERD is effectively treated and if symptoms are still present, one should consider tracheal resection.