Gastroesophageal reflux disease and chronic sinusitis: in search of an esophageal-nasal reflex.
BACKGROUND
This study was performed to explore whether or not a neural reflex linking the esophagus and the nasal airway exists, as a pathogenic mechanism accounting for the association between gastroesophageal reflux (GER) disease and chronic rhinosinusitis (CRS). A prospective trial of healthy human volunteers was performed.


METHODS
Ten healthy volunteers without GER or sinonasal disease were investigated using an acid infusion challenge test. Normal saline and hydrochloric acid were infused into the lower esophagus through an esophageal manometry catheter. Nasal responses in symptom score, nasal inspiratory peak flow, and mucus production were analyzed after the esophageal challenge.


RESULTS
A tendency for an increase in nasal mucus production was observed after esophageal stimulation with both normal saline and HCl. This returned to baseline level 45 minutes after the acid infusion. A similar trend was also observed with the measurements of nasal symptom scores and, to a lesser extent, nasal inspiratory peak flow.


CONCLUSIONS
These results support the possibility that a neural reflex exists between the esophagus and the paranasal sinuses via the vagus nerve. If indeed present, the reflex-mediated rhinitis derived from this neuropathic inflammation may contribute to the development of CRS in patients with GER. Further study is required to define the relationship between GER and CRS.
Wong
Ian W Y
IW
Department of Surgery-Otolaryngology Head and Neck Surgery, Adelaide University, South Australia, Australia.
Rees
Guy
G
Greiff
Lennart
L
Myers
Jennifer C
JC
Jamieson
Glyn G
GG
Wormald
Peter-John
PJ
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D004947:Esophagus / Q000187:drug effects* / Q000294:innervation / Q000502:physiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000139:chemically induced* / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D006851:Hydrochloric Acid / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009093:Mucus / Q000187:drug effects / Q000378:metabolism; D009297:Nasal Mucosa / Q000187:drug effects* / Q000294:innervation / Q000502:physiology; D020078:Neurogenic Inflammation; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012852:Sinusitis / Q000139:chemically induced* / Q000276:immunology / Q000503:physiopathology; D014630:Vagus Nerve / Q000276:immunology
D006851:Hydrochloric Acid