Background: Chronic rhinitis is a diffuse disease with a prevalence of 40% in western world. Vasomotor rhipopathy rappresents the main cause of chronic rhinitis and is classified in Allergic Rhinitis (AR) and Non Allergic Rhinitis (NAR) (AR/NAR = 2.4/1). Nasal cytology allows to identify the different NAR sub-types on the basis of the inflammatory cell infiltrate: nonallergic rhinitis with neutrophils (NARNE), nonallergic rhinitis with eosinophils (NARES), nonallergic rhinitis with mast cells (NARMA) and nonallergic rhinitis with eosinophils and mast cells (NARESMA). NAR etiopathogenesis is not wet clarified and for NARNE subtype has been suggested GERD as one of the etiopathogenetic factors. Aim: To evaluate the role of GERD on patients affected by NARNE. Materials and methods: Fifty one consecutive patients (mean age 51.29 ± 15.69 years; M/F = 18/33) referred to our ENT unit for nasal symptoms such as: rhinorrhea, sneezing, and postnasal drip, presenting non allergic rhinitis were enrolled in the study. Visual analogue scale (VAS) for nasal symptoms, rhinomanometry, skin prick test and nasal cytology were performed. Exclusion criteria were environmental irritant exposure and/or a positive skin prick test. All the patients performed a gastroenterological evaluation, a high resolution esophageal manometry and a 24 hour pH-Impedance monitoring. Results: Twenty five (49%) patients tested positive at nasal cytology for the presence of neutrophils in nasal mucosa (neutrophils >50% with absent spores and bacteria) (NARNE) while the remaining twenty six (51%) were negative. Apart from drainage, no significant differences were observed between the two groups with regard to symptoms (Table 1). At the univariate analysis, the only significant difference between the groups was higher proportion of patients in the group with neutrophilic rhinitis testing positive at pH-impedance and with a less intense drainage (Table 1).The logistic regression analysis confirmed the significant relationship between being positive at pH-impedance and having a neutrophilic rhinitis (P < 0.0001, Table 2), while a stronger drainage was more likely associated with a non-neutrophilic rhinitis (P < 0.0001, Table 2). Table 1 NARNE N = 25 NON NARNE N = 26 P Age 46.08 (17.66) 56.30 (11.82) 0.0249 Sex 14F/6M 19F/7M Ns Nasal Obstruction 4.36 (3.25) 3.57 (3.47) Ns Pruritus 0.4 (1) 1.03 (1.58) Ns Rinorrhea 2.92 (3.21) 2.30 (2.57) Ns Drainage 3.28 (3.40) 5.57 (2.80) 0.0175 Starnuti 0.84 (1.79) 1.76 (2.02) Ns Positive pHmetry 20 5 <0.0001 Table 2 Logistic regression analysis Variable Odds ratio 95% CI Positive pH-impedenziometry 22.4635 4.4559 to 113.2458 Drainage 0.7454 0.5826 to 0.9537 Conclusion: Our preliminary study reports a positive correlation between GERD and NARNE. Therefore in patients affected by NARNE pH-impedance study should be performed to establish GERD diagnosis. Additional studies is needed to confirm that result.
Chronic non allergic rhinitis with neutrophilis (NARNE) and gastroesophageal reflux disease (GERD): A possible correlation?
IOANNOU, ALEXANDROS;SCHIAVON, PATRIZIA;Azzaroli, F;Mandolesi, D;CIMATTI, MARIA CHIARA;Pirodda, A;Bazzoli, F;Torresan, F.
2017
Abstract
Background: Chronic rhinitis is a diffuse disease with a prevalence of 40% in western world. Vasomotor rhipopathy rappresents the main cause of chronic rhinitis and is classified in Allergic Rhinitis (AR) and Non Allergic Rhinitis (NAR) (AR/NAR = 2.4/1). Nasal cytology allows to identify the different NAR sub-types on the basis of the inflammatory cell infiltrate: nonallergic rhinitis with neutrophils (NARNE), nonallergic rhinitis with eosinophils (NARES), nonallergic rhinitis with mast cells (NARMA) and nonallergic rhinitis with eosinophils and mast cells (NARESMA). NAR etiopathogenesis is not wet clarified and for NARNE subtype has been suggested GERD as one of the etiopathogenetic factors. Aim: To evaluate the role of GERD on patients affected by NARNE. Materials and methods: Fifty one consecutive patients (mean age 51.29 ± 15.69 years; M/F = 18/33) referred to our ENT unit for nasal symptoms such as: rhinorrhea, sneezing, and postnasal drip, presenting non allergic rhinitis were enrolled in the study. Visual analogue scale (VAS) for nasal symptoms, rhinomanometry, skin prick test and nasal cytology were performed. Exclusion criteria were environmental irritant exposure and/or a positive skin prick test. All the patients performed a gastroenterological evaluation, a high resolution esophageal manometry and a 24 hour pH-Impedance monitoring. Results: Twenty five (49%) patients tested positive at nasal cytology for the presence of neutrophils in nasal mucosa (neutrophils >50% with absent spores and bacteria) (NARNE) while the remaining twenty six (51%) were negative. Apart from drainage, no significant differences were observed between the two groups with regard to symptoms (Table 1). At the univariate analysis, the only significant difference between the groups was higher proportion of patients in the group with neutrophilic rhinitis testing positive at pH-impedance and with a less intense drainage (Table 1).The logistic regression analysis confirmed the significant relationship between being positive at pH-impedance and having a neutrophilic rhinitis (P < 0.0001, Table 2), while a stronger drainage was more likely associated with a non-neutrophilic rhinitis (P < 0.0001, Table 2). Table 1 NARNE N = 25 NON NARNE N = 26 P Age 46.08 (17.66) 56.30 (11.82) 0.0249 Sex 14F/6M 19F/7M Ns Nasal Obstruction 4.36 (3.25) 3.57 (3.47) Ns Pruritus 0.4 (1) 1.03 (1.58) Ns Rinorrhea 2.92 (3.21) 2.30 (2.57) Ns Drainage 3.28 (3.40) 5.57 (2.80) 0.0175 Starnuti 0.84 (1.79) 1.76 (2.02) Ns Positive pHmetry 20 5 <0.0001 Table 2 Logistic regression analysis Variable Odds ratio 95% CI Positive pH-impedenziometry 22.4635 4.4559 to 113.2458 Drainage 0.7454 0.5826 to 0.9537 Conclusion: Our preliminary study reports a positive correlation between GERD and NARNE. Therefore in patients affected by NARNE pH-impedance study should be performed to establish GERD diagnosis. Additional studies is needed to confirm that result.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
