The role of Gastro Esophageal Reflux in Chronic Rhinosinusitis

Background: Chronic Rhino Sinusitis (CRS) is one of the most prevalent chronic disorders in industrialized countries. The disease has a major negative impact on quality of life, social and professional capacity as well as health in general. The etiology is multifactorial and partly unknown. As patients may have symptoms inadequately controlled, despite treatment as recommended by internationally validated guidelines, there is a need to understand more of this disease. It has been discussed for decades if gastroesophageal reflux (GER) may have a role in the pathogenesis of CRS in some patients. Objectives: The main aim of this research was to obtain a better understanding of the role of GER in CRS and to get a final answer to the question: Is there an association between GERD and CRS? Investigating the sino- and nasal-quality of life in patients with gastroesophageal reflux disease (GERD) compared to a control population. Assessing the occurrence of reflux in CRS-patients with the 24-hour multichannel intraluminal impedance pH-monitoring. Evaluating the presence and level of pepsin in saliva and nasal secretions, in CRS-patients compared to age and gender matched healthy controls. Methods: Three controlled studies were carried out, one on GERD-patients and two on CRSpatients. We used the 20-item Sino-Nasal Outcome Test in GERD-patients and a healthy control group. We performed 24-hour esophageal multichannel impedance pH-monitoring in CRS-patients and compared the results with data from a European trial on healthy subjects. We used the Peptest®, an assay for detection of pepsin, to evaluate the findings of pepsin in CRS-patients and an age and gender matched group of healthy controls. Results: Patients with GERD had a reduced nose- and sinus-related quality of life compared to a control group based on having a significantly higher total SNOT-20 score. Accordingly, this study indicates that there may be an association between GERD and CRS. CRS-patients had significantly higher incidence of gastroesophageal reflux compared with asymptomatic controls as measured with 24-h esophageal multichannel impedance-pH monitoring. As measured by the Peptest, we did not find more pepsin in saliva or nasal secretions in CRS-patients than in healthy controls, nor in those with high GerdQ scores or verified proximal reflux. We measured high concentrations of pepsin in both patients and healthy controls. This indicates a limited validity of the Peptest as screening tool for GER in CRS. Conclusions: The reduced sino- nasal quality of life in GERD-patients compared to healthy controls indicates a possible link between GERD and CRS. More reflux in CRS-patients compared to asymptomatic controls and the proximal extent of refluxate further indicates a link. High concentrations of pepsin in nasal secretion and saliva in both CRS-patients and healthy controls, as measured with Peptest, indicates a limited validity of the test for diagnostic purposes of GERD-induced CRS. The limited validity is further confirmed by the absent correlation between Peptest and proximal reflux as measured with 24- hour multichannel impedance pH-monitoring