(The fifth patient was lost to follow-up.) The findings suggest that premalignant lesions may be associated with GERD and may resolve after appropriate antireflux therapy. 10 All patients subsequently underwent antireflux surgery, and the laryngeal abnormalities resolved in three of four patients. In the study mentioned above, five patients with GERD were found to have laryngeal squamous cell carcinoma and underwent either surgical or radiation therapy edema and leukoplakia persisted after treatment. However, in the presence of GERD, leukoplakia is considered to be precancerous. 3, 10, 11 Leukoplakia, defined as the presence of a whitish plaque on a mucosal surface, in itself does not carry any diagnostic implications. GERD has also been implicated in the development of leukoplakia and squamous cell carcinoma of the true vocal cords. Untreated, GERD can lead to chronic laryngitis, dysphonia, chronic sore throat, chronic cough, constant throat clearing, granuloma of the true vocal cords and other problems. Treatment should be initiated with a histamine H 2 receptor blocker or proton pump inhibitor. Erythema of the posterior larynx may be seen, and the true vocal cords may be edematous. Laryngoscopy can confirm the diagnosis of laryngopharyngeal reflux. Thus, a high index of suspicion is required. While the most common head and neck symptom is a globus sensation (a lump in the throat), the head and neck manifestations can be diverse and may be misleading in the initial work-up. An estimated 20 to 60 percent of patients with GERD have head and neck symptoms without any appreciable heartburn. Besides the typical presentation of heartburn and acid regurgitation, either alone or in combination, GERD can cause atypical symptoms. Gastroesophageal reflux disease (GERD) is the most common esophageal disease.
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