For years, doctors have recognized the frequent overlap of gastroesophageal reflux disease (GERD) and chronic sinus problems in patients. It now seems that for those who suffer from both, GERD medicine may also help relieve sinusitis symptoms.Researchers from the University of Nebraska Medical Center and the National University of Ireland studied eleven patients with chronic resistant sinusitis (CRS) that did not respond to treatment. Eight of the eleven reported having heartburn at least once a week, and nine, upon examination, were found to have abnormal acid content in their esophagus. The eleven CRS patients were compared to nineteen patients with GERD but no sinus problems.
The patients in each group were tested for esophageal pH (acid content) and underwent several tests for GERD and CRS symptoms. The two groups had similar results in pH tests and esophageal manometry. The patients with only GERD had more throat abnormalities, including laryngitis, while the patients with CRS had more abnormal results in the nasal endoscopy.
Following the baseline tests, the eleven patients with CRS were given 20 mg of omeprazole (brand name Prilosec) twice a day for three months. Tests were repeated at the end of the three-month study.
While the treatment didn’t get rid of sinusitis entirely, most of the patients experienced modest improvement in their symptoms. 25% to 89% of patients reported improvement in specific symptoms, including nasal congestion, nasal drainage, sinus pressure, facial headache, and malaise. The patients reported a 91% rate of overall satisfaction.
The reason for the overlap in conditions is not known, but it is fairly common, especially in children. This may be due to their smaller size — reflux has less distance to travel to reach the nasal cavity. In adults, however, the distance is greater, and the acid must pass through not only the esophageal sphincter, but also through a second sphincter at the top of the throat. This condition is called laryngopharyngeal reflux (LPR) and is less common. The throat is much more sensitive to the acid than the esophagus is, and is also closer to the sinuses.
Omeprazole is a proton pump inhibitor (PPI), which treats GERD by blocking the stomach pumps that produce acid. It has no direct effect on the sinuses, yet CRS patients felt a modest improvement in their symptoms after using omeprazole.
This study, published in the February 2002 issue of the American Journal of Gastroenterology, was a small preliminary trial. Because of its size, results were not conclusive, but the authors recommended a "further randomized, controlled study in a larger population" because of its promising results.
