Is reflux noted at diagnostic rigid oesophagoscopy clinically significant?

Area of Science:

• Otolaryngology
• Gastroenterology
• Medical Diagnostics

Background:

• Gastro-esophageal reflux disease (GERD) is a common condition.
• Accurate diagnosis of GERD is crucial for effective patient management.
• Otolaryngologists frequently encounter patients with symptoms potentially related to GERD.

Purpose of the Study:

• To evaluate the diagnostic accuracy of otolaryngologists in identifying GERD using rigid endoscopy.
• To assess the current clinical practices of otolaryngologists regarding GERD diagnosis and management.
• To compare endoscopic findings with objective reflux testing.

Main Methods:

• A telephone survey of 25 senior otolaryngologists was conducted.
• 21 patients diagnosed with GERD via rigid endoscopy over two years were retrospectively analyzed.
• Endoscopic findings (fluid, erythema) were compared with subsequent esophageal pH and manometry studies.

Main Results:

• 21/25 otolaryngologists reported treating suspected GERD with proton pump inhibitors without further testing.
• Rigid endoscopy diagnosed GERD in 21 patients based on visual cues.
• Only 9 out of 21 (47.6%) patients were confirmed as refluxers by pH and manometry, indicating low diagnostic accuracy for endoscopy alone.

Conclusions:

• Rigid endoscopy findings for GERD in the aerodigestive tract and upper esophagus have a diagnostic accuracy below 50%.
• Relying solely on endoscopic visualization for GERD diagnosis can lead to misdiagnosis.
• Objective testing like pH monitoring and manometry is essential for confirming GERD in otolaryngology practice.