title: Evidence of extraesophageal reflux in idiopathic subglottic stenosis.
abstract: OBJECTIVE
  Idiopathic subglottic stenosis (iSGS) is a disease predominantly of females that, by definition, has no known etiology. Collagen-vascular disease, localized trauma, extraesophageal reflux (EER), and hormonal alterations have all been postulated as potential etiologies of iSGS. It is hypothesized that iSGS is a reflux mediated disease and that evidence of EER exists in affected patients.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Patients with iSGS were identified prospectively over a 2.5-year period (2007-2010). During their endoscopic management, biopsies of the subglottic scar and postcricoid area were evaluated for the presence of pepsin, an indicator of exposure to gastric refluxate. Control patients had similar biopsies while undergoing operative management for disease unrelated to reflux. Charts of both patients and controls were reviewed for clinical history of reflux, pH-metry, and laboratory testing for collagen-vascular disease.
  
  
  RESULTS
  Twenty-two patients with iSGS were treated. All patients were female. No patient had serology positive for collagen-vascular disease. Thirteen (59%) patients with iSGS had pepsin present in their larynx or trachea. Control patients did not have detectable pepsin in their tissue (P = .041). Dual probe 24-hour pH studies were performed in 10 (45%) patients. These studies were positive for EER in seven patients but this did not statistically correlate to the presence of pepsin in their tissue (P = 1.0).
  
  
  CONCLUSIONS
  iSGS is a disease almost exclusively of women. EER is implicated in the development of iSGS. Pepsin is detectable in the subglottic scar and larynges of patients with iSGS. Standard pH-metry may be inadequate in predicting degree of EER in patients with iSGS.
authors.affiliation: Division of Laryngology & Professional Voice, Department of Otolaryngology & Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. jblumin@mcw.edu
authors.forename: Joel H
authors.initials: JH
authors.lastname: Blumin
authors.forename: Nikki
authors.initials: N
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015153:Blotting, Western; D016022:Case-Control Studies; D004591:Electrophoresis, Polyacrylamide Gel; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D006801:Humans; D007829:Laryngostenosis / Q000209:etiology* / Q000473:pathology; D007830:Larynx / Q000378:metabolism; D008875:Middle Aged; D009092:Mucous Membrane / Q000473:pathology; D010434:Pepsin A / Q000378:metabolism; D011127:Polyps / Q000150:complications; D014132:Trachea / Q000378:metabolism; D014826:Vocal Cord Paralysis / Q000150:complications
chemical_list: D010434:Pepsin A