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News

GERD-related laryngitis diagnosis differs between specialities

March's issue of the American Journal of Gastroenterology shows that there is a dichotomy in treatment dose, duration, and perceived patient response to therapy between ear, nose, and throat physicians, and gastroenterologists.

News image

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Ear, nose, and throat physicians often diagnose gastroesophageal reflux disease (GERD)-related laryngitis.

This diagnosis is made on the basis of symptoms and laryngeal signs.

Patients may be referred to gastroenterologists who contend that many such patients do not have reflux.

Dr Tasneem Ahmed and colleagues from Ohio assessed this practice pattern differences among physicians and gastroenterologists.

The research team evaluated the differences in relation to the diagnosis and treatment of patients with GERD-related laryngitis.

Separate surveys were specifically designed for physicians and gastroenterologists.

Many gastroenterologists perform pre-therapy tests with low sensitivity in GERD-related laryngitis
American Journal of Gastroenterology

The surveys assessed the percentage of patients diagnosed with GERD-related laryngitis, as well as dose and duration of therapy.

Treatment response, and other diagnostic options in nonresponders were also assessed.

The team randomly mailed surveys to the American Academy of Otolaryngology Head and Neck Surgery and the American Gastroenterological Association.

Of the total 4,000 surveys sent, 39% of the ear, nose, and throat physicians and 28% of gastroenterologists responded.

The researchers observed that most respondents were private practitioners.

From the ear, nose, and throat survey, the diagnosis was most commonly based on symptoms such as globus, or throat clearing, cough, and hoarseness.

The team found that the most useful signs were laryngeal erythema and edema reported by 70% of respondents.

Of the ear, nose, and throat physicians, 74% reported they made the diagnosis more on symptoms than on laryngeal signs.

These physicians initiated therapy most often with proton pump inhibitor (PPI) once daily for 2 months.

The team noted that gastroenterologists were divided on pre-therapy testing.

About 50% reporting testing with esophagogastro-duodenoscopy followed by pH monitoring prior to therapy.

The researchers observed that the remaining 50% reported treating empirically with PPI twice daily for 3 months.

Of the gastroenterologists, 70% reported treatment response of less than 60%.

However, 62% of ear, nose, and throat physicians reported a response rate of greater than 60%.

Dr Ahmed's team concluded, “Globus and throat clearing were considered the most useful symptoms in diagnosing GERD-related laryngitis for ear, nose, and throat physicians.”

“Laryngeal erythema and edema were considered the most useful signs for diagnosis and treatment of this condition by ear, nose, and throat physicians.”

“However, these symptoms and signs may represent the least specific markers for reflux.”

“Many gastroenterologists perform pre-therapy testing which has low sensitivity in GERD-related laryngitis.”

“There is a dichotomy in treatment dose, duration, and perceived patient response to therapy between the 2 specialists.”

“Our study highlights a need for cross communication and education between these 2 disciplines in understanding and treating GERD-related laryngitis better.”

Am J Gastroenterol 2006: 101(3): 470
14 March 2006

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