GERD and Pharyngeal Erythema: Relationship and Diagnostic Considerations
Laryngoscopic findings such as pharyngeal erythema can be observed in patients with GERD symptoms, but these findings lack specificity as they can also be present in asymptomatic individuals or be caused by other conditions unrelated to reflux. 1
Relationship Between GERD and Pharyngeal Findings
Extraesophageal reflux (EER), a subset of gastroesophageal reflux disease (GERD), can manifest with laryngeal and pharyngeal symptoms and signs, including potential erythema of the pharynx 1
Laryngoscopy is commonly used to evaluate patients with extraesophageal symptoms, with findings such as erythema or edema of the arytenoids or vocal folds sometimes attributed to reflux 1
Common laryngeal findings attributed to reflux include laryngeal edema, erythema, posterior pharyngeal wall pachydermia, and vocal process granuloma 1
Diagnostic Limitations
Diagnosis of extraesophageal reflux by laryngoscopy alone lacks specificity to identify GERD as the etiology for extraesophageal symptoms 1
Laryngeal findings thought to be related to reflux (including erythema) can be observed in asymptomatic volunteers and can be caused by etiologies other than GERD 1
There are inconsistent relationships between laryngoscopic abnormalities and objective esophageal reflux monitoring 1
Inter-rater and intra-rater reliability in assessing these findings is problematic, with concerns about correlation between physical findings, patient-reported symptoms, and response to treatment 1
Evidence from Clinical Studies
In studies of patients with suspected laryngopharyngeal reflux, common laryngeal findings include arytenoid erythema, vocal cord erythema and edema, posterior commissure hypertrophy, and arytenoid edema 2
ENT physicians often diagnose GERD-related laryngitis based on symptoms and laryngeal signs, with 70% reporting laryngeal erythema and edema as the most useful diagnostic signs 3
However, these symptoms and signs may represent the least specific markers for reflux, leading to disagreement between ENT physicians and gastroenterologists regarding diagnosis and management 3
Multidisciplinary Approach to Diagnosis
No single diagnostic tool can conclusively identify GERD as the cause of extraesophageal symptoms including pharyngeal erythema 1
Determination of the contribution of GERD to extraesophageal symptoms should be based on the global clinical impression derived from patients' symptoms, response to GERD therapy, and results of endoscopy and reflux testing 1
A multidisciplinary approach with communication between treating disciplines (gastroenterology, otolaryngology, etc.) results in the best outcomes for suspected extraesophageal reflux patients 1
Clinical Implications
The presence of pharyngeal erythema alone is insufficient to diagnose GERD as the cause of pharyngeal symptoms 1
Laryngoscopy is valuable for identifying alternative diagnoses responsible for extraesophageal symptoms rather than confirming GERD 1
When evaluating patients with suspected extraesophageal manifestations of GERD, clinicians should consider multiple potential etiologies beyond reflux 1
Empiric treatment with proton pump inhibitors may be considered in patients with suspected reflux-related pharyngeal symptoms, but response rates vary and lack of response should prompt consideration of other diagnoses 2, 4
In conclusion, while GERD can potentially cause pharyngeal erythema as part of its extraesophageal manifestations, this finding lacks specificity and must be interpreted cautiously within the broader clinical context, including symptoms, response to therapy, and results of other diagnostic tests.