Gastroesophageal Reflux and Chronic Rhinosinusitis Interactions

Gastroesophageal reflux disease and chronic rhinosinusitis frequently co-exist, suggesting shared pathophysiological mechanisms and reciprocal influence on symptom severity. Microaspiration of acidic or non-acidic gastric contents may provoke mucosal inflammation in the nasal and sinus cavities, leading to persistent epithelial injury, ciliary dysfunction and altered local immune responses. Conversely, chronic sinonasal inflammation can exacerbate laryngopharyngeal reflexes and lower oesophageal sphincter relaxation, perpetuating reflux episodes. Clinical presentations often overlap, with patients reporting nasal congestion, post-nasal drip, throat clearing and heartburn. Diagnostic challenges arise from nonspecific symptoms and the lack of universally accepted biomarkers. Therapeutic interventions range from lifestyle modifications and acid-suppressive therapy to endoscopic sinus surgery and adjunctive nasal treatments. Evidence increasingly supports a multidisciplinary approach, in which effective reflux control may improve sinonasal outcomes and vice versa. Understanding these bidirectional interactions has global significance, as both conditions impose substantial healthcare and quality-of-life burdens.

Research from Nature Portfolio

Recent analyses of proton pump inhibitor (PPI) prescription data have revealed a clear association between PPI use and the onset of chronic rhinosinusitis. Individuals currently using PPIs exhibited a substantially higher odds ratio for developing chronic rhinosinusitis with or without nasal polyps compared with non-users, even after adjustment for demographic and comorbidity factors. The strength of association persisted across subgroups defined by duration of PPI use and remained consistent in both male and female cohorts. These findings underscore the importance of careful evaluation of acid-suppressive regimens in patients presenting with refractory sinonasal symptoms and highlight the need to explore alternative gastro-oesophageal therapies or step-down strategies to mitigate potential sinonasal side effects.

Gastroesophageal Reflux and Chronic Rhinosinusitis Interactions publication trend

The graph below shows the total number of articles in gastroesophageal reflux and chronic rhinosinusitis interactions across all publications each year (not limited to Nature Index journals).

Technical terms

Gastroesophageal reflux disease (GERD): A condition in which stomach contents reflux into the oesophagus, causing mucosal injury and symptoms such as heartburn.

Chronic rhinosinusitis (CRS): A prolonged inflammatory disorder of the nasal and paranasal sinus mucosa lasting more than 12 weeks, often with nasal obstruction and discharge.

Proton pump inhibitor (PPI): A class of medications that suppress gastric acid secretion by inhibiting the H+/K+ ATPase enzyme in parietal cells.

Laryngopharyngeal reflux (LPR): The backflow of gastric contents into the larynx and pharynx, often presenting with throat clearing, hoarseness or chronic cough.

Helicobacter pylori: A gram-negative bacterium that colonises gastric mucosa and has been detected in extragastric sites, potentially contributing to chronic inflammation.

References

1. Relation between chronic rhinosinusitis and gastroesophageal reflux in adults: systematic review. Brazilian Journal of Otorhinolaryngology (2016).
2. The association between chronic rhinosinusitis and proton pump inhibitor use: a nested case–control study using a health screening cohort. Scientific Reports (2022).
3. Gastritis and gastroesophageal reflux disease are strongly associated with non-allergic nasal disorders. BMC Pulmonary Medicine (2021).
4. Endoscopic Features of Chronic Rhinosinusitis in Patients with Gastroesophageal Reflux Disease. Medicina (2024).
5. The potential role of Helicobacter pylori in chronic rhinosinusitis with or without nasal polyposis. The Egyptian Journal of Otolaryngology (2024).