Comparison between the Reflux Finding Score and the Reflux Symptom Index in the Practice of Otorhinolaryngology

Abstract Introduction The Gastroesophageal Reflux Disease has a prevalence of 12% of the urban population in Brazil. Koufman proposed the term to designate Laryngeal Pharyngeal Reflux (LPR) symptoms, signs or tissue damage resulting from aggression of the gastrointestinal contents in the upper aerodigestive tract. Belafsky et al proposed a score that points to inflammatory laryngeal signs through videolaryngoscopic findings, the Reflux Finding Score (RFS). Moreover, in 2002, they published the Reflux Symptom Index (RSI). Objective The objective of this study is to provide a comparison between the Reflux Finding Score and the Reflux Symptom Index in the practice of Otorhinolaryngology. Methods Our study involved a total of 135 patients who visited the Ear, Nose, and Throat (ENT) clinic Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo between April 2014 and May 2015 with suspected LPR.We excluded nine patients and the study group was 126 patients. All patients were ranked by their RSI and RFS scores. Results The study group consisted of 126 patients (88 women and 38 men). Their main complaints were cough (40.4%), globus (21.4%), dysphonia (19.8%), throat clearing (15.8%), postnasal drip (3.17%), snoring (1.5%), dysphagia (1.5%), cacosmia (0.7%), and regurgitation (1.5%). The RSI ranges from 13 to 42 with a mean of 20.7 (SD = 6.67). The RFS ranged from 3 to 19 with a mean of 9.53 (SD = 2.64). Conclusion The RSI and RFS can easily be included in ENT routines as objective parameters,with low cost and high practicality. Based on the clinical index, the specialist can evaluate the need for further tests.

Doença do refluxo gastroesofágico / Gastroesophageal reflux disease

A doença do refluxo gastroesofágico (DRGE) é considerada uma das afecções mais prevalentes em todo o mundo, podendo comprometer de forma significativa a qualidade de vida dos pacientes. Trata-se de uma afecção crônica que se desenvolve quando o refluxo do conteúdo gástrico causa sintomas incomodativos ou complicações, sendo sintomas incomodativos aqueles definidos pelos pacientes.

Gastric reflux disease (GERD) is considered one of the most prevailing sickness in all over the world that can affect meaningfully patient?s quality of life. It?s a case of chronic sickness which is developed when reflux of gastric contents causes disturbing, that are defined by patients, or complications.

Síntomas digestivos y respuesta clínica en lactantes con alergia a la proteína de leche de vaca / Gastrointestinal symptoms and clinical response of infants with cow's milk protein allergy

Introducción: La calidad de vida y estado nutricional del lactante con alergia a la proteína de leche de vaca (APLV) pueden comprometerse sin un adecuado diagnóstico y tratamiento oportuno. Objetivo: Describir síntomas digestivos, antecedentes familiares y perinatales, estado nutricional y respuesta de lactantes < 12 meses con APLV entre junio de 2007 y agosto de 2011. Pacientes y Método: Estudio retrospectivo, descriptivo en lactantes < 12 meses de edad que consultan por sospecha de APVL. Se investigaron antecedentes familiares, perinatales y características clínicas. Se excluyó a los casos sin prueba de alimentación o provocación abierta, o cuyo motivo de consulta correspondió a otra patología. Se usó el programa STATA especial edición 11,1 para el análisis estadístico. Se consideró estadístico y significativo un p < 0,05. Resultados: Se diagnosticaron 40 lactantes (57,5 por ciento varones), edad 3,0 +/- 0,4 meses, clínica de 2 +/- 0,3 meses de: vómito/regurgitación: 20, diarrea sanguinolenta: 8, falla en el crecimiento: 4, cólico/irritabilidad: 4, deposición normal con sangre en 3. Los antecedentes familiares y perinatales fueron ingesta de biberón en la 1ª semana de vida: 35, madre > 30 años: 31 casos, atopia en 2 familiares (padres/hermanos): 28, parto por cesárea: 27. Al seguimiento de 14 +/- 1,4 meses, 19 respondieron a fórmula ampliamente hidrolizada +/- seno; 19 a fórmula de aminoácidos +/- seno y un paciente lactancia exclusiva. El Z-score de P/E:-1,05 +/- 1,28; T/E: -0,96 +/- 1,60; IMC: -0,61 +/- 1,03 en primera consulta, mejoró al año: P/E: -0,15 +/- 1,24; T/E: -0,29 +/- 1,14 e IMC: -0,04 +/- 1,20 (p < 0,05), independiente de la fórmula (p = NS). Veintitres toleraron leche entera al año. Conclusiones: En este estudio los síntomas predominantes al inicio de los pacientes con APLV fueron vómitos, regurgitación y diarrea sanguinolenta. Entre los antecedentes destacan la exposición temprana a PLV, atopia familiar y parto por cesárea...

Introduction: Quality of life and nutritional status of infants with cow's milk protein allergy (CMA) can be compromised without a proper diagnosis and treatment. Objective: To describe digestive symptoms, family and perinatal history and nutritional status of < 12 month infants with CMA between June 2007 and August 2011. Patients and Method: A retrospective and descriptive study in < 12 month old infants suspecting CMA was performed. Family history, perinatal and clinical characteristics were studied. Cases without food test or open challenge test, or whose reason for consultation corresponded to other pathology were excluded. The program STATA 11.1 was used for statistical analysis and p < 0.05 was considered statistically significant. Results: 40 infants (57.5 percent boys), age 3 +/- 0.4 months and history of 2 +/- 0.3 months presenting the following: 20 of them (50 percent, vomiting/regurgitation; 8 (20 percent, bloody diarrhea; 4 (10 percent) failure to thrive; 4 (10 percent), colic/irritability and bloody normal deposition was present in 3 individuals (7.5 percent). Family and perinatal history: 35 (87.5 percent were bottle-fed during the first week of life; 31 (77.5 percent) had > 30 year old mothers; 28 (70 percent described 2 family members (parents/siblings) with atopy; 27 (67.5 percent were delivered via cesarean. At the 14 +/- 1.4-month follow-up, 19 (47.5 percent responded to extensively hydrolyzed formula +/- breastfeeding; 19 to amino acid formula +/- breastfeeding and one patient to breastfeeding exclusively. The Z -score for P/E was: -1.05 +/- 1.28; T/E: -0.96 +/- 1.60; BMI: -0.61 +/- 1.03 in the first consultation; after a year, scores improved: P/E: -0.15 +/- 1.24; T/E: -0.29 +/- 1.14 and BMI: -0.04 +/- 1.20 (p < 0.05), independent from formula (p = NS). 23 (74 percent) tolerated whole milk when reached a year old. Conclusions: In this study, the predominant early symptoms were...

Doença do refluxo gastroesofágico / Gastroesophageal reflux disease

A doença do refluxo gastroesofágico (DRGE) é uma afecção crônica frequente na prática médica, interferindo negativamente na qualidade de vida dos pacientes. Apresenta um amplo espectro de sintomas, classificados como típicos e atípicos, sendo a pirose a principal manifestação. O tratamento inclui medidas comportamentais farmacológicas e eventualmente cirúrgicas

Gastroesophageal reflux disease (GERD) is a common chronic condition that affects negatively the patient's quality of life. Patients with GERD can exhibit a wide variety of symptoms, both typical and atypical. Heartburn is the main clinical presentation. Treatment consists of supportive and pharmacological measures; surgery may eventually be required

Clinical Significance of Incidentally Detected Eosinophilic Esophagitis with Pathologic Review / 대한소화기학회지

BACKGROUND/AIMS: Eosinophilic esophagitis (EE) is a chronic inflammatory disorder characterized by abnormal dense eosinophilic infiltration of esophageal mucosa and results in dysphasia and food impaction. EE is being increasingly recognized in adults. The prevalence is largely unknown. This study was performed to evaluate the detection rate of EE diagnosed based on pathologic criteria and to define the clinical characteristics of EE in Korea. METHODS: We reviewed biopsy specimen of the 1,609 patients who underwent esophageal biopsy from January 2006 till August 2008. The presence of more than 20 eosinophils per high power field in biopsy specimens was considered cases of EE. Clinical information and endoscopic findings were obtained. RESULTS: 7 (0.4%) patients were diagnosed as EE based on pathologic criteria retrospectively. Clinical symptoms were epigastric pain (43%), regurgitation (29%), dyspepsia (14%), and no symptom (14%). Endoscopic findings were whitish exudates or granules (57%), esophageal polyp (29%), and hyperemic change (14%). Two patients received treatment. One patient with bronchial asthma improved after treatment with inhaled corticosteroid, and one patient improved after 8 week proton pump inhibitor therapy. CONCLUSIONS: Eosinophilic esophagitis was found in 0.4% of the total esophageal biopsied cases. Our results suggest that Korean patients with eosinophilic esophagitis showed symptoms mimicking gastroesophageal reflux disease and atypical endoscopic findings. Therefore, regardless of the gross appearance of the mucosa, meticulous diagnostic approaches are needed for patients with swallowing difficulty and lack of response to proton pump inhibitor.