Development of Physiology- and Pathophysiology-based Diagnostic Tests and Therapeutics for Patients With Pharyngeal Reflux of Gastric Content

Study subjects: we will study gastroesophageal reflux disease (GERD) patients with complaint of regurgitation and one of the following supra-esophageal symptoms attributed to reflux of gastric content: chronic cough, frequent throat clearing, history of non-deglutitive aspiration pneumonia, hoarse voice, chronic sinusitis and dental erosion i.e. Supraesophageal gastroesophageal reflux disease (SE-GERD). The presence of GERD will be verified in their records by result of prior endoscopy or pH monitoring within the past two years. It not, they will undergo transnasal esophagogastroduodenoscopy (T-EGD). If negative, they will undergo pH monitoring off medications to ascertain presence of GERD according to clinically accepted criteria (AGA guidelines (39). We will not enroll patients with functional heartburn (Rome III criteria (40). For Supra-esophageal complications we will use the endoscopic criteria used in clinical Ear, Nose and Throat (ENT) practice and validated symptom severity index questionnaire (developed by Belafsky et al) with the help of our otolaryngologist co-investigator Dr. Joel Blumin.

Study position: studies will be done in supine postures due to vulnerability of the airway in this position.

Instrumentation: all instrumentations will be trans-nasal following application of 2% lidocaine limited to the nasal cavity.

Study technique: concurrent video-pharyngo-laryngoscopy and combined high-resolution manometry and impedance recording along with pH monitoring.

All study participants will give written informed consent followed by filling out a general health questionnaire. Additionally, a Belafsky Index will also be filled out in the same session by the study participant to assess the level of symptoms within the last month associated with supraesophageal reflux.