Compared to the situation in western countries, reflux esophagitis is relatively rare in Japan. With the recent trend towards aging and the increasingly Westernized diet in this country, the incidence of this disease is now on the rise. Researchers have long highlighted anassociation between refluxes ophagitis and vocal cord nodules, nonspecific inflammatory granulation and other conditions of the larynx. In the West, reflux esophagitis is regarded as important from the viewpoint of managing dysphonia.
In the present communication, we report the results of an investigation into the etiological factors associated with reflux esophagitis. Endoscopic examination of the esophagus was performed in order to detect the presence of lesions in esophageal mucosa of 49 patients. These patients had laryngeal or hypopharyngeal redness, swelling or drug-resistant reflux esophagitis, and were selected, from patients with paresthesias of the pharynx and larynx who attended 7 institutions between June 1995 and February 1997. Proton pump inhibitors were administered to these patients, and thier therapeutic efficacy investigated by comparing the subjective symptoms, laryngeal or hypopharyngeal findings, and endoscopic findings. The assessment of the severity of the endoscopic findings was performed using the Los Angeles classification with the addition of Grade-O, in which no mucosal breaks were observed; thus the classification had 5 grades: G-O, G-A, G-B, G-C, and G-D.
Prior to the treatment, 33 patients were evaluated by endoscopy as G-O, 10 as G-A, 2 as G-B, 4 as G-C, and 0 as G-D. Furthermore, a high incidence of reflux esophagitis was observed 32.7% (16/49). The improvement in subjective symptoms after 8 weeks of treatment with lansoprazole was 75.5% (37/49). On endoscopy, there was no deterioration of the symptoms observed in the G-O patients. In contrast, the degree of improvement in the 16 patients assessed as G-A and above was 75% (12/16). Based on these findings, we conclude that reflux esophagitis frequently shows a strong association with paresthesias of the pharynx and larynx, and that treatment with lansoprazole is effective for this condition.
