Reflux Disease May Cause Sinusitis and Damage Teeth

A review of studies by Medical College of Wisconsin physicians suggests that gastric acid refluxed up the esophagus may damage structures other than the esophagus and result in various health conditions including sinus infections and eroded teeth and gums.

The effects of gastroesophageal reflux disease (GERD), whose most prominent symptom is typically heartburn, were studied by Medical College researchers Jeegar A. Jailwala, MD, Fellow in Gastroenterology & Hepatology, and Reza Shaker, MD, Professor and Chief of Gastroenterology & Hepatology, and Director of the Medical College Digestive Disease Center. Dr. Shaker is part of the Froedert & Medical College Gastroenterology Program. Their work is reported in the Journal of Clinical Gastroenterology (Vol.30s, pp.535-538).

There is clear evidence in both healthy as well as GERD patient populations that refluxed gastric acid may come in contact with structures as high as the pharynx. The pharynx is the cavity leading from the mouth and nasal passages ultimately to the esophagus. In GERD patients, the frequency and the contact time of the acid with mucous membranes in the pharynx is much greater.

A history of regurgitation -- in which stomach contents are refluxed into the mouth -- particularly at night, associated with cough, is a significant clue to the possibility of GERD complications that reach beyond the esophagus. A history of repetitive throat clearing, recurring hoarseness (particularly in the morning), and bad breath may be symptoms of acid reflux-related conditions extending beyond the esophagus. In one study, only 43% of patients suspected of ear/nose/throat complications from GERD had classic symptoms of heartburn, regurgitation, or difficulty swallowing.

Recent reports indicate that acid reflux into the pharynx plays a role in the development of sinusitis in both children and adults. There was also a study showing that patients with GERD were less likely to get relief from sinus surgery. In patients with chronic sinusitis (inflammation of the sinuses), a large number of acid reflux events reach the top of the esophagus near the sinuses compared to a control group. While acid reflux probably does not reach all the way to the sinuses, it could induce inflammation of nasal mucous, blocking the sinuses. The exact cause-and-effect mechanism of acid reflux and sinusitis has not yet been established.

Many reports have suggested that regurgitated gastric acid damages the teeth. Recent evidence has strengthened the possible association of reflux and dental erosions. Dental erosions involve the loss of dental enamel by a chemical process that does not involve bacteria (such as occurs in typical teeth cavities). The prevalence of dental erosions in the general population is estimated at 2-18%, but has been reported to range between 20-55% among individuals with GERD.

GERD may also cause globus pharyngeus, a chronic sensation of a lump in the throat -- without any physical findings. This can be so serious in some patients that it prevents them from eating on a regular basis, resulting in weight loss. Treatment of mild GERD typically involves over-the-counter anti-acids. More severe cases may require prescription medication, or even surgery. In addition, a new, non-operative endoscopic technique has been tested and may be appropriate for selective patients.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.