Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T17:41:40.926Z Has data issue: false hasContentIssue false
  • English
  • Français

Aspiration and development of subglottic stenosis in patients with Wegener’s granulomatosis

Published online by Cambridge University Press:  25 November 2009

A C Church ,
K Goldsmith  and
P Sivasothy
A C Church*
Affiliation:
Scottish Pulmonary Vascular Unit, Golden Jubilee Hospital, Glasgow, Scotland, UK
K Goldsmith
Affiliation:
Department of Respiratory Medicine, Papworth Hospital, Cambridge, England, UK
P Sivasothy
Affiliation:
Department of Respiratory Medicine, Papworth Hospital, Cambridge, England, UK
*
Address for correspondence: Dr A C Church, Golden Jubilee Hospital, Beardmore Street, Clydebank, Glasgow G81 4HX, Scotland, UK. Fax: +44 (0)141 2329423 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

In patients with Wegener’s granulomatosis, subglottic stenosis can develop due to active disease; however, some patients develop subglottic stenosis with no clear evidence of airway inflammation. In some cases of idiopathic subglottic stenosis, an association with gastroesophageal reflux disease has been found. Our study assessed the potential role of gastroesophageal reflux as an aetiological factor in the development of subglottic stenosis in patients with Wegener’s granulomatosis.

Design:

We assessed evidence of active reflux disease, using 24-hour pH monitoring and assessment of bile salts in bronchoalveolar lavage fluid.

Subjects:

Ten Wegener’s granulomatosis patients with subglottic stenosis underwent 24-hour pH monitoring and bronchoscopy and lavage of the right middle lobe. A similar number of control patients were included.

Results:

There was no statistically significant difference in the occurrence of bronchoalveolar bile salts in patients with subglottic stenosis (n = 2) versus control patients (zero) (p = 0.457). There was good correlation between the detection of reflux by 24-hour pH monitoring and the detection of bronchoalveolar bile salts (κ = 0.769).

Conclusion:

In this small study of patients with Wegener’s granulomatosis, there was no evidence of an association between the development of subglottic stenosis and gastroesophageal reflux.

Keywords

Wegener’s GranulomatosisSubglottic StenosisGastroesophageal Reflux
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 4 , April 2010 , pp. 393 - 396
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the American Thoracic Society meeting, 15 May 2007, San Francisco, USA.

References

1 Gottschlich, S, Ambrosch, P, Kramkowski, D, Laudien, M, Buchelt, T, Gross, WL et al. Head and neck manifestations of Wegener's granulomatosis. Rhinology 2006;44:227–33Google ScholarPubMed
2 Daum, TE, Specks, U, Colby, TV, Edell, ES, Brutinel, MW, Prakash, UB et al. Tracheobronchial involvement in Wegener's granulomatosis. Am J Respir Crit Care Med 1995;151:522–6CrossRefGoogle ScholarPubMed
3 Cordier, JF, Valeyre, D, Guillevin, L, Loire, R, Brechot, JM. Pulmonary Wegener's granulomatosis. A clinical and imaging study of 77 cases. Chest 1990;97:906–12CrossRefGoogle ScholarPubMed
4 Maronian, NC, Azadeh, H, Waugh, P, Hillel, A. Association of laryngopharyngeal reflux disease and subglottic stenosis. Ann Otol Rhinol Laryngol 2001;110:606–12Google Scholar
5 Blondeau, K, Mertens, V, Vanaudenaerde, BA, Verleden, GM, Van Raemdonck, DE, Sifrim, D et al. Gastro-oesophageal reflux and gastric aspiration in lung transplant patients with or without chronic rejection. Eur Respir J 2008;31:707–13CrossRefGoogle ScholarPubMed
6 Sweet, MP, Patti, MG, Hoopes, C, Hays, SR, Golden, JA. Gastro-oesophageal reflux and aspiration in patients with advanced lung disease. Thorax 2009;64:167–73CrossRefGoogle ScholarPubMed
7 D'Ovidio, F, Mura, M, Tsang, M, Waddell, TK, Hutcheon, MA, Singer, LG et al. Bile acid aspiration and the development of bronchiolitis obliterans after lung transplantation. J Thorac Cardiovasc Surg 2005;129:1144–52CrossRefGoogle ScholarPubMed
8 Solans-Laque, R, Bosch-Gil, J, Canela, M, Lorente, J, Pallisa, E, Vilardell-Tarres, M. Clinical features and therapeutic management of subglottic stenosis in patients with Wegener's granulomatosis. Lupus 2008;17:832–6CrossRefGoogle ScholarPubMed
9 Gluth, MB, Shinners, PA, Kasperbauer, JL. Subglottic stenosis associated with Wegener's granulomatosis. Laryngoscope 2003;113:1304–7CrossRefGoogle ScholarPubMed
10 Kauer, WK, Peters, JH, DeMeester, TR, Feussner, H, Ireland, AP, Stein, HJ et al. Composition and concentration of bile acid reflux into the esophagus of patients with gastroesophageal reflux disease. Surgery 1997;122:874–81Google Scholar
11 D'Ovidio, F, Mura, M, Ridsdale, R, Takahashi, H, Waddell, TK, Hutcheon, M et al. The effect of reflux and bile acid aspiration on the lung allograft and its surfactant and innate immunity molecules SP-A and SP-D. Am J Transplant 2006;6:1930–8CrossRefGoogle ScholarPubMed
12 Hoffman, GS, Thomas-Golbanov, CK, Chan, J, Akst, LM, Eliachar, I. Treatment of subglottic stenosis, due to Wegener's granulomatosis, with intralesional corticosteroids and dilation. J Rheumatol 2003;30:1017–21Google ScholarPubMed
13 Nouraei, SA, Obholzer, R, Ind, PW, Salama, AD, Pusey, CD, Porter, F et al. Results of endoscopic surgery and intralesional steroid therapy for airway compromise due to tracheobronchial Wegener's granulomatosis. Thorax 2008;63:49–52Google Scholar