Refractory ENT/GERD Symptoms – is Upper Esophageal Sphincter (UES) or Esophageal Body the Culprit?

Abstract

Purpose: Patients with ENT symptoms suspected due to GERD refractory to antireflux therapy present a diagnostic challenge. Significant proportions of these patients have reflux controlled on medication but with little or no symptom relief. Little attention has been paid to potential motility abnormalities – particularly in the UES – in this group. Aim: To review esophageal function studies in patients with ENT symptoms referred for evaluation of refractory GERD. Methods: Retrospective review of esophageal function studies between 07/2003–11/2006. All patients referred by a single ENT specialist were included and esophageal function studies reviewed for presence or absence of abnormalities in the lower esophageal sphincter (LES), esophageal body, and UES. Bolus transit was assessed by simultaneous impedance performed with manometry. Results: Ninety-four of 117 patients referred by this single specialist had esophageal function studies available for review. Symptoms included voice change (45%), chronic cough or throat clearing (30%), heartburn (20%) as well as a variety of other ENT symptoms. Hypertensive UES seen in 29/94 (31%). High residual pressure in 20/94 (21%). UES relaxation duration abnormal in 19 of 94 (20%). Ten of 94 (9%) had hypertensive UES and elevated residual pressure. Overall, 53% had some abnormality in the UES. Ineffective esophageal body motility was seen in 16/94 (17%), otherwise no esophageal body abnormality was consistently seen. Normal viscous and liquid transit was found in 65/94 patients (69%). 29/94 patients had an abnormal transit and in half of these it was limited to either one or the other. LES abnormalities were likewise infrequent in this population. UES abnormalities are a common finding in ENT patients with symptoms suspected due to GERD refractory to high-dose antisecretory therapy. Motility abnormalities are seen rarely though abnormal bolus transit is seen in a potentially important number of patients. Conclusion: Further studies need to be done to determine if these associations are clinically important.