Gastroesophgeal reflux and chronic sinusitis: causal relationship and outcome of antireflux therapy

ABSTRACT

The cause of chronic sinusitis is multi- factorial, but nasal edema appears to be the initial pathologic step. The objective of this study was to evaluate the possible association of refractory chronic sinusitis with gastroesophageal reflux and the response of reflux therapy with regard to sinus symptoms. The study included 50 patients with chronic sinusitis who failed to respond to maximal medical treatment. 28[56%] were males and 22[44%] were females. Age ranged from 4-42 years with a mean of 16.22 years. Patients underwent 24- hour monitoring with double pH probes and were evaluated for their response to antireflux therapy with regard to their sinus symptoms. The study revealed prevalence of GER among patients with refractory chronic sinusitis than anticipated in the general population [44% versus 5%]. The prevalence was higher in patients <16 years than in patients >16 years. This was statistically significant [P<0.005]. Antireflux therapy resulted in a significant symptom resolution in all patients [P<0.05]. Also, comparison of symptom resolution score in patients <16 years and those >16 years showed significant difference [P<0.001]. Our study concluded that GER should be considered as a possible cause of nasal edema and hence chronic sinusitis and a course of antireflux therapy, for at least 3 months, should be prescribed before decision to proceed to surgery especially in children