Case report
Idiopathic Tracheal Stenosis: Successful Outcome With Antigastroesophageal Reflux Disease Therapy

https://doi.org/10.1016/j.athoracsur.2007.10.032Get rights and content

There is controversial evidence that gastroesophageal reflux disease (GERD) is an etiologic factor for idiopathic laryngotracheal stenosis. We present the case of a 44-year-old woman with symptomatic tracheal stenosis managed as idiopathic stenosis. She underwent six endoscopic dilations during 1 year, and before surgery she underwent 24-hour esophageal pH monitoring that documented GERD. Anti-GERD treatment was started, which was confirmed as effective with 24-hour esophageal pH monitoring 3 months later. At 2-year follow-up the patient remained free of symptoms and no additional airway procedure was necessary. A close relationship between anti-GERD therapy and clinical outcome was noted.

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Idiopathic laryngotracheal stenosis includes lesions that share typical features of location, configuration, clinical evolution, and pathologic findings. This patient had some of these features, as well as female sex, fifth decade of life, and upper tracheal stenosis, with no history of intubation, trauma, infection, or collagen vascular disease (eg, Wegener granulomatosis or relapsing polychondritis). Therefore, a diagnosis of ILTS was made [1]. Because of good results of surgical treatment in

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    The incidence of dysphagia was less than 15%, and it was not different between patients with normal and abnormal esophageal manometry findings. Unlike other airway or lung diseases, such as asthma,4,5 pulmonary fibrosis,3 bronchiolitis obliterans,19,20 and airway hyperresponsiveness, the few studies21-23 on the correlation between airway stenosis and GER are focused on idiopathic subglottic airway stenosis where the presence of gastric juice yields to tissue remodeling through the stimulation of the differentiation of fibroblasts into myofibroblasts.24 As far as postintubation tracheal stenosis is concerned, the treatment of reflux and its impact on the outcome of the stenosis have been scarcely reported.

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    It occurs mainly in women, suggesting that estrogens have an important role in this entity.118–121 Other authors suggest that it may be associated with GERD.122,123 Although evaluation of the flow-volume loop may suggest the diagnosis, multi-slice CT and bronchoscopy (Fig. 1, image 7) are essential for confirmation.124–126

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    However, Dedo and associates2 and others3 failed to find estrogen receptors in the stenotic tissue samples. Gastroesophageal reflux disease has also been considered in the etiology of ILTS,3 with some reports of improvement of ILTS with antireflux therapy.4 Continued rarity of ILTS cases despite continuously increasing gastroesophageal reflux disease and intensive endoscopic surveillance programs, however, do not support the role of reflux in etiology of ILTS.

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