The integrity of esophagogastric junction anatomy in patients with isolated laryngopharyngeal reflux symptoms.
BACKGROUND
Distortion of esophagogastric junction anatomy in patients with gastroesophageal reflux disease produces permanent dilation of the gastric cardia proportional to disease severity, but it remains unclear whether this mechanism underlies reflux in patients with isolated laryngopharyngeal reflux symptoms.


METHODS
In a prospective study, 113 patients were stratified into three populations based on symptom complex: laryngopharyngeal reflux symptoms, typical reflux symptoms, and both laryngopharyngeal and typical symptoms. Subjects underwent small-caliber upper endoscopy in the upright position. Outcome measures included gastric cardia circumference, presence and size of hiatal hernia, and prevalence of esophagitis and Barrett's esophagus within each group.


RESULTS
There were no differences in gastric cardia circumference between patient groups. The prevalence of Barrett's esophagus was 20.4% overall and 15.6% in pure laryngopharyngeal reflux patients. Barrett's esophagus patients had a greater cardia circumference compared to those without it. In the upright position, patients with isolated laryngopharyngeal reflux display the same degree of esophagogastric junction distortion as those with typical reflux symptoms, suggesting a similar pathophysiology.


CONCLUSIONS
This indicates that, although these patients may sense reflux differently, they have similar risks as patients with typical symptoms. Further, the identification of Barrett's esophagus in the absence of typical reflux symptoms suggests the potential for occult disease progression and late discovery of cancer.
Perry
Kyle A
KA
Department of Surgery, Oregon Health & Science University, Portland, OR, USA.
Enestvedt
C Kristian
CK
Lorenzo
Cedric S F
CS
Schipper
Paul
P
Schindler
Joshua
J
Morris
Cynthia D
CD
Nason
Katie
K
Luketich
James D
JD
Hunter
John G
JG
Jobe
Blair A
BA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis; D002299:Cardia / Q000473:pathology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004943:Esophagogastric Junction / Q000473:pathology* / Q000503:physiopathology; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D007830:Larynx / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000473:pathology* / Q000503:physiopathology; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index