Is pharyngeal (back of throat) redness a common symptom of Gastroesophageal Reflux Disease (GERD)?

Pharyngeal Redness in GERD: Diagnostic Considerations

Pharyngeal redness (erythema) can be observed in patients with GERD but is not specific to the condition as it 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 2, 1
• Common laryngeal findings attributed to reflux include laryngeal edema, erythema, posterior pharyngeal wall changes, and vocal process granuloma 1
• Laryngoscopy is commonly used to evaluate patients with extraesophageal symptoms, with findings such as erythema of the arytenoids or vocal folds sometimes attributed to reflux 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

Clinical Implications

• The presence of pharyngeal erythema alone is insufficient to diagnose GERD as the cause of pharyngeal symptoms 2, 1
• No single diagnostic tool can conclusively identify GERD as the cause of extraesophageal symptoms including pharyngeal erythema 2
• 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 2

Extraesophageal Manifestations of GERD

• Possible extraesophageal manifestations of GERD include cough, laryngeal hoarseness, dysphonia, pulmonary fibrosis, asthma, dental erosions/caries, sinus disease, ear disease, post-nasal drip, and throat clearing 2
• Patients with EER may not complain of heartburn or regurgitation; thus, the clinician must determine whether acid reflux is contributing to the symptoms 2
• The difficulties in confirming a causal association between reflux and EER symptoms relate to variable responses to PPI therapy 2

Diagnostic Approach

• When evaluating patients with suspected extraesophageal manifestations of GERD, clinicians should consider multiple potential etiologies beyond reflux 2, 1
• A multidisciplinary approach with communication between treating disciplines (gastroenterology, otolaryngology, etc.) results in the best outcomes for suspected extraesophageal reflux patients 2
• Laryngoscopy is valuable for identifying alternative diagnoses responsible for extraesophageal symptoms rather than confirming GERD 1

Common Pitfalls

• Assuming that pharyngeal erythema is specific to GERD when it can be caused by multiple conditions or even be present in asymptomatic individuals 1
• Relying solely on laryngoscopic findings without considering the overall clinical picture 2
• Failing to consider non-GERD causes of pharyngeal symptoms and signs 2, 1
• Initiating acid suppression therapy based solely on the finding of pharyngeal erythema without additional supporting evidence of GERD 2, 1