The Prevalence of Gastoesophageal Reflux in Extra Thoracic Airway Obstruction

Abstract

Purpose: This is a prospective prevalence study of GER in patients diagnosed with Extra Thoracic Airway Obstruction (ETAO). Background: ETAO is a debilitating disorder, in which sufferers develop dysfunctional vocal cord movement, blocking inspiration. The diagnosis is defined by wheezing not due to asthma, with no response to beta agonist medications and closure of the vocal cords during inspiration documented on larygoscopy. Currently the standard of care is counseling and speech training to learn to control the rate of breathing and relax the vocal cords. The prevalence of ETAO is estimated at 3–5% of all patients diagnosed with asthma and may be higher in patients who are more physically fit. There is a small but growing body of evidence that ETAO triggers include post-nasal drip, airborne irritants and GER in addition to stress and increased ventillation. The prevalence of GER in asthma is 60–80% in most studies. There have been no studies to determine the prevalence of GER in ETAO. We assessed the prevalence of GER and patient characteristics in patients with ETAO using the BRAVO pH monitor. Methods: Patients with documented ETAO were recruited from the pulmonary or speech pathology service. Patients who consented to enrollment completed a demographic sheet and two questionnaires: a survey of airway symptoms and a survey of GER symptoms. Patients then underwent EGD with standard placement of a Bravo pH probe. GER was defined as an abnormal pH score or esophagitis on EGD. 54 patients seen by the pulmonary and speech pathology services were evaluated and offered enrollment with 12 ultimately enrolling. Results: 42% (95%CI 15–72) of patients with ETAO were documented to have GER. Conclusions: In this preliminary report, the incidence of GER in ETAO was 42%, lower than commonly reported in asthma. To date there were no significant predictors of GER in ETAO patients. While empiric GER treatment may be reasonable as adjunctive therapy in ETAO, GER is likely not the primary trigger of ETAO symptoms.Table 1