Reflux threat to upper airway might be missed

Physicians treating patients with asthma and other airway symptoms should not rely solely on gastroenterologists’ interpretations of pH probe tests, because they might miss laryngeal-pharyngeal reflux that threatens the upper airway, said at a meeting on allergy/clinical immunology, asthma, and pulmonary medicine.

Gastroenterologists may not be familiar with patients with asthma, chronic cough, or laryngitis, and pH probe patterns may look unfamiliar in the context of what they usually see, said by one allergist doctor with the National Jewish Medical and Research Center in Denver. If they don’t find something significant in the lower esophagus, they may miss something significant in the larynx or pharynx.

Asthma patient with suspected gastro-esophageal reflux (GER) or laryngeal-pharyngeal reflux (LPR) are a heterogeneous population in terms of esophageal acidification. Some patients have short episodes of reflux and others show prolonged episodes associated with esophageal injury.

GI doctors are very good at treating GER with proton pump inhibition therapy, which appears to work best in the most severe cases.  But when patients have short periods of acid reflux that are full column to the top probe and don’t result in prolonged acid exposure, they don’t know what it means, and we see this same pattern in LPR.

Some of the patterns and parameters that are known to injure the esophagus are not necessarily seen in airway dysfunction patients, but that doesn’t mean they aren’t having significant reflux that might go into the esophagus has many defense mechanisms against acid, other compounds in reflux might damage the airway.

Bile and enzymes from the duodenum do not show up on a pH probe, and when you get all the way up out of the esophagus into the LP area, those tissues do not have some of the defenses that the esophagus does. Symptoms might be generated merely from those protective mechanisms being repeatedly triggered by non-acidic material.

Our message to doctors treating airway disease is simple: Either has a close relationship with your GI doc if he or she shows an interest in airway disease, or looks at these probe studies yourself and sees if the patterns are posing significant problems that are correlated with patients’ symptoms or disease.