The yield of upper gastrointestinal endoscopy in patients with suspected reflux-related chronic ear, nose, and throat symptoms

Am J Gastroenterol. 2004 Aug;99(8):1419-26. doi: 10.1111/j.1572-0241.2004.30066.x.


Objectives: It is well established that various ENT disorders and symptoms may be a manifestation of gastroesophageal reflux disease (GERD). Erosive esophagitis is considered a rare finding in ENT patients and therefore upper gastrointestinal (GI) endoscopy is not recommended in the diagnostic work-up. However, large prospective studies underscoring this policy are lacking. The aim of the present study was to investigate the prevalence and severity of esophagitis in patients with suspected GERD-related chronic ENT symptoms.

Methods: Endoscopy was performed in 405 ENT patients with suspected GERD and 545 typical GERD patients. The presence of erosive esophagitis, Barrett's esophagus, hiatal hernia, peptic ulcer, and Helicobacter pylori infection on biopsies was determined and compared with the results of a symptom questionnaire.

Results: The prevalence of erosive esophagitis (52.3% vs 38.4%; p < 0.05), mainly grade 1 (31.9% vs 22.7%; p < 0.05), and of peptic ulcer (8.4% vs 4.3%; p < 0.05) was significantly higher in patients with GERD-related ENT symptoms compared to typical GERD. Barrett's mucosa occurred in, respectively, 4.9% and 4.5% of the patients (NS). Esophagitis prevalence was highest in patients with predominant cough and lowest in globus pharyngeus and throat symptoms. The presence of esophagitis was associated with significantly higher rates of symptom relief during the first 8 wk of proton pump inhibitor (PPI) therapy.

Conclusions: Patients with suspected GERD-related ENT symptoms have a high prevalence of esophagitis and this is associated with better response to antisecretory therapy.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Ulcer Agents / therapeutic use
  • Barrett Esophagus / diagnosis
  • Chronic Disease
  • Cough / etiology
  • Esophagitis, Peptic / diagnosis
  • Esophagoscopy*
  • Female
  • Gastroesophageal Reflux / complications*
  • Gastroesophageal Reflux / diagnosis*
  • Gastroesophageal Reflux / drug therapy
  • Gastroscopy*
  • Heartburn / etiology
  • Hernia, Hiatal / diagnosis
  • Humans
  • Male
  • Middle Aged
  • Otorhinolaryngologic Diseases / etiology*
  • Peptic Ulcer / diagnosis
  • Pharyngeal Diseases / etiology


  • Anti-Ulcer Agents