Association between Laryngopharyngeal Reflux, Gastroesophageal Reflux
and Recalcitrant Chronic Rhinosinusitis: A Systematic Review.
Abstract
Objective: To investigate the association between laryngopharyngeal
reflux (LPR), gastroesophageal reflux disease (GERD) and recalcitrant
chronic rhinosinusitis (CRS). Data sources: PubMed, Cochrane Library,
and Scopus. Review methods: Three investigators search database for
studies investigating the relationship between LPR, GERD and
recalcitrant CRS with or without polyposis. The following outcomes were
investigated with PRISMA criteria: age; gender; reflux and CRS
diagnosis; association outcomes and potential treatment outcomes.
Authors performed a bias analysis of papers and provided recommendations
for future studies. Results: A total of 17 studies investigated the
association between reflux and recalcitrant CRS. According to pharyngeal
pH monitoring, 54% of patients with recalcitrant CRS reported hypo or
nasopharyngeal acid reflux events. The numbers of hypo- and
nasopharyngeal acid reflux events were significantly higher in patients
compared to healthy individuals in 4 and 2 studies, respectively. Only
one report did not find group differences. The proportion of GERD was
significantly higher in CRS patients compared to controls, with a
prevalence ranging from 32% to 91% of cases. No author considered
nonacid reflux events. There was an important heterogeneity in the
inclusion criteria; definition of reflux and association outcomes,
limiting the draw of clear conclusion. Pepsin was found in sinonasal
secretions more frequently in CRS patients than controls. Conclusion:
Laryngopharyngeal reflux and GERD may be a contributing factors of CRS
therapeutic resistance, but future studies are still needed to confirm
the association considering nonacid reflux event.