HSC Section 6 Nov2016 Green Book

II.

BRONCHOESOPHAGOLOGY A. Esophageal Dysphagia

Kocdor P, Siegel ER, Tulunay-Ugur OE. Cricopharyngeal dysfunction: a systematic review comparing outcomes of dilatation, botulinum toxin injection, and myotomy. Laryngoscope . 2016; 126(1):135-141. EBM level 2a............................................106-112 Summary: This systematic review of cohort studies evaluated the outcomes between different interventions for cricopharyngeal (CP) dysfunction, including CP dilation, botulinum toxin injections, and myotomy. The authors found that there was a significant increase in the odds of success and decreased complication rates with endoscopic myotomy versus open myotomy. They also found that myotomy was more effective than botulinum toxin injections. Miles A, McMillan J, Ward K, Allen J. Esophageal visualization as an adjunct to the videofluoroscopic study of swallowing. Otolaryngol Head Neck Surg . 2015; 152(3):488-493. EBM level 4..................................................................................113-118 Summary: Miles et al hypothesize that esophageal disorders are the cause for dysphagia in many patients and propose that studying the esophagus as part of videofluoroscopic study of swallowing will yield greater diagnosis of abnormalities. Their findings suggest that esophageal disease is common and sometimes is the only abnormality in patients with cervical dysphagia. Furthermore, esophageal abnormalities frequently coexist with oral and pharyngeal disorders. Moawad FJ, Veerappan GR, Dias JA, et al. Randomized controlled trial comparing aerosolized swallowed fluticasone to esomeprazole for esophageal eosinophilia. Am J Gastroenterol . 2013; 108(3):366-372. EBM level 1b............................................119-125 Summary: This single-blinded, randomized controlled trial compared the efficacy of swallowed aerosolized steroids (fluticasone) to a proton pump inhibitor (omeprazole) for the treatment of eosinophilic esophagitis (EOE)–an important cause of esophageal dysphagia. Gastroesophageal reflux disease (GERD) patients were stratified equally into each arm. GERD patients with eosinophilia had improvement in their dysphagia symptoms and eosinophilia in biopsy specimens with PPI treatment alone. Current guidelines recommend failed trial of PPI prior to formal diagnosis of EOE due to this “newer” entity of PPI-responsive EOE. Peng KA, Feinstein AJ, Salinas JB, Chhetri DK. Utility of the transnasal esophagoscope in the management of chemoradiation-induced esophageal stenosis. Ann Otol Rhinol Laryngol . 2015; 124(3):221-226. EBM level 4......................................................126-131 Summary: This article establishes the applications and safety of the transnasal esophagoscope (TNE) for chemoradiation-induced pharyngoesophageal swallowing dysfunction. Through use of a modified dysphagia score, the Functional Outcome Swallowing Scale (FOSS), the authors also suggest efficacy of TNE-based procedures in the population. B. Esophagopharyngeal Reflux Jetté ME, Gaumnitz EA, Birchall MA, et al. Correlation between reflux and multichannel intraluminal impedance pH monitoring in untreated volunteers. Laryngoscope . 2014; 124(10):2345-2351. EBM level 1b......................................132-138

Summary: This study shows that the Reflux Finding Score (RFS) is not specific to detect laryngopharyngeal reflux in healthy volunteers, suggesting that other things can cause laryngeal inflammation.