{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T14:04:38Z","timestamp":1768313078827,"version":"3.49.0"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T00:00:00Z","timestamp":1722556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Chronic rhinosinusitis (CRS) is a complex inflammatory condition affecting the nasal and paranasal sinus mucosa. Gastroesophageal reflux disease (GERD) has been implicated as a potential exacerbating factor in CRS, but the specific endoscopic features of nasopharyngeal pathology in this context remain poorly understood. Background and Objectives: Chronic rhinosinusitis is a multifactorial disease with various underlying etiologies, including inflammation, anatomical factors, and environmental triggers. While gastroesophageal reflux disease has been suggested as a potential contributor to chronic rhinosinusitis, the specific endoscopic features indicative of nasopharyngeal pathology in CRS patients with GERD symptoms have not been clearly elucidated. Our aim is to identify specific endoscopic features of nasopharyngeal pathology in patients with CRS associated with GERD symptoms and to propose a method for assessing the influence of gastroesophageal reflux disease on the mucosal layer of the nose and nasopharynx. Materials and Methods: We conducted a cross-sectional observational study involving 521 adult patients presenting with symptoms suggestive of CRS. From this cohort, 95 patients with the highest scores on the Reflux Symptom Index (RSI) and Reflux Symptom Score-12 (RSS-12) questionnaires were selected as the main group. Endoscopic examinations were performed to assess the nasal and nasopharyngeal mucosa. Results: Our study revealed significant alterations in the nasopharyngeal mucosa of patients with CRS associated with GERD symptoms. Increased vascularity of the nasopharyngeal mucosa was observed in 91 patients (95.7%), while hypertrophy was noted in 83 patients (87.4%). Mucus was present in the nasopharynx of 77 patients (81.1%), exhibiting varying characteristics of color and consistency. Asymmetric hypertrophy of the oropharyngeal mucosa was noted in 62 patients (65.3%). Conclusions: We propose a method for assessing the influence of gastroesophageal reflux disease on the mucosal layer of the nose and nasopharynx, which may aid in diagnostic and management decisions. Further research is warranted to explore the potential impact of GERD symptoms on the course and severity of CRS exacerbations.<\/jats:p>","DOI":"10.3390\/medicina60081257","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T13:14:42Z","timestamp":1722604482000},"page":"1257","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Endoscopic Features of Chronic Rhinosinusitis in Patients with Gastroesophageal Reflux Disease"],"prefix":"10.3390","volume":"60","author":[{"given":"Kalamkas","family":"Sagandykova","sequence":"first","affiliation":[{"name":"\u201cUniversity Medical Center\u201d Corporate Fund, School of Medicine, Nazarbayev University (NUSOM), Astana 010000, Kazakhstan"},{"name":"Department of Otorhinolaryngology, NpJSC \u201cAstana Medical University\u201d, Astana 010000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nataliya","family":"Papulova","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, NpJSC \u201cAstana Medical University\u201d, Astana 010000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Talapbek","family":"Azhenov","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, NpJSC \u201cAstana Medical University\u201d, Astana 010000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aliya","family":"Darbekova","sequence":"additional","affiliation":[{"name":"Medical Center Hospital of the President\u2019s Affairs Administration of the Republic of Kazakhstan, Astana 010000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bayan","family":"Aigozhina","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, NpJSC \u201cAstana Medical University\u201d, Astana 010000, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0845-0845","authenticated-orcid":false,"given":"Jerome R.","family":"Lechien","sequence":"additional","affiliation":[{"name":"Laryngopharyngeal Reflux Study Group, Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), 13005 Paris, France"},{"name":"Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, 78180 Paris, France"},{"name":"School of Medicine, University Paris Saclay, 91190 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4193\/Rhin20.401","article-title":"European Position Paper on Rhinosinusitis and Nasal Polyps 2020","volume":"58","author":"Fokkens","year":"2020","journal-title":"Rhinology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1136\/gutjnl-2023-330616","article-title":"Updates to the modern diagnosis of GERD: Lyon consensus 2.0","volume":"73","author":"Gyawali","year":"2024","journal-title":"Gut"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1097\/00005537-200108000-00001","article-title":"The validity and reliability of the reflux finding score (RFS)","volume":"111","author":"Belafsky","year":"2001","journal-title":"Laryngoscope"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1002\/lary.28962","article-title":"Changes of Laryngeal and Extralaryngeal Symptoms and Findings in Laryngopharyngeal Reflux Patients","volume":"131","author":"Lechien","year":"2021","journal-title":"Laryngoscope"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1001\/jamaoto.2022.1638","article-title":"Association Between Inferior Turbinate Hypertrophy and Extraesophageal Reflux","volume":"148","author":"Tedla","year":"2022","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_6","first-page":"CD011996","article-title":"Intranasal steroids versus placebo or no intervention for chronic rhinosinusitis","volume":"4","author":"Chong","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1002\/alr.22741","article-title":"International consensus statement on allergy and rhinology: Rhinosinusitis 2021","volume":"11","author":"Orlandi","year":"2021","journal-title":"Int. Forum Allergy Rhinol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1016\/S0140-6736(19)31881-1","article-title":"Efficacy and safety of dupilumab in patients with severe chronic rhinosinusitis with nasal polyps (LIBERTY NP SINUS-24 and LIBERTY NP SINUS-52): Results from two multicentre, randomised, double-blind, placebo-controlled, parallel-group phase 3 trials","volume":"394","author":"Bachert","year":"2019","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Tai, J., Han, M., and Kim, T.H. (2022). Therapeutic Strategies of Biologics in Chronic Rhinosinusitis: Current Options and Future Targets. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23105523"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/S0892-1997(02)00097-8","article-title":"Validity and reliability of the reflux symptom index (RSI)","volume":"16","author":"Belafsky","year":"2002","journal-title":"J. Voice"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1177\/0194599820941003","article-title":"Development and Validation of the Short Version of the Reflux Symptom Score: Reflux Symptom Score-12","volume":"164","author":"Lechien","year":"2021","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1002\/lary.24923","article-title":"Inferior turbinate classification system, grades 1 to 4: Development and validation study","volume":"125","author":"Camacho","year":"2015","journal-title":"Laryngoscope"},{"key":"ref_13","first-page":"6945297","article-title":"Predictors of Nasal Obstruction: Quantification and Assessment Using Multiple Grading Scales","volume":"2016","author":"Camacho","year":"2016","journal-title":"Plast. Surg. Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1111\/coa.13005","article-title":"Eight weeks of omeprazole 20 mg significantly reduces both laryngopharyngeal reflux and comorbid chronic rhinosinusitis signs and symptoms: Randomised, double-blind, placebo-controlled trial","volume":"43","author":"Turkalj","year":"2018","journal-title":"Clin. Otolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"E294","DOI":"10.1002\/lary.24538","article-title":"Role of pepsin and pepsinogen: Linking laryngopharyngeal reflux with otitis media with effusion in children","volume":"124","author":"Luo","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1177\/0003489414526689","article-title":"Nasopharyngeal acid reflux and Eustachian tube dysfunction in adults","volume":"123","author":"Brunworth","year":"2014","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e57","DOI":"10.1136\/flgastro-2022-102184","article-title":"Ear, nose and throat (ENT) manifestations and complications of reflux","volume":"13","author":"Brar","year":"2022","journal-title":"Frontline Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1007\/s00405-023-08350-w","article-title":"Causal analysis between gastroesophageal reflux disease and chronic rhinosinusitis","volume":"281","author":"Chen","year":"2024","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1177\/0003489419888947","article-title":"Validity and Reliability of the Reflux Sign Assessment","volume":"129","author":"Lechien","year":"2020","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1177\/0194599817697055","article-title":"PepsinA as a Marker of Laryngopharyngeal Reflux Detected in Chronic Rhinosinusitis Patients","volume":"156","author":"Ren","year":"2017","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"227","DOI":"10.4193\/Rhin18.005","article-title":"The symptom burden of autonomic dysfunction is positively associated with chronic rhinosinusitis status","volume":"56","author":"Chen","year":"2018","journal-title":"Rhinology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1007\/s40136-018-0215-3","article-title":"Outcome Measures in Chronic Rhinosinusitis","volume":"6","author":"Ting","year":"2018","journal-title":"Curr. Otorhinolaryngol. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.anl.2021.11.011","article-title":"Laryngopharyngeal reflux in chronic rhinosinusitis patients and the role of endoscopic sinus surgery","volume":"49","author":"Yeo","year":"2022","journal-title":"Auris Nasus Larynx"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1097\/01.MLG.0000163751.00885.63","article-title":"Direct nasopharyngeal reflux of gastric acid is a contributing factor in refractory chronic rhinosinusitis","volume":"115","author":"DelGaudio","year":"2005","journal-title":"Laryngoscope"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/8\/1257\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:28:59Z","timestamp":1760110139000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/60\/8\/1257"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,2]]},"references-count":24,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["medicina60081257"],"URL":"https:\/\/doi.org\/10.3390\/medicina60081257","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,2]]}}}