**6. Diagnosis**

132 Gastrointestinal Endoscopy

Fig. 6. Schematic illustration of cytokeratin (CK) 7 and 20 expression in the normal esophagus, Barrett's metaplasia, squamocolumnar junction, and proximal stomach. LATCHFORD A et al. Gut 2001; 49:746-747 (*Reprinted with permission from GUT BMJJournal*) (Latchford et al., 2001). even weakly acidic secretion can cause symptoms. Others have proposed that mucin secretion can also cause symptoms (Bajbouj et al., 2009). Proximal esophagus dysmotility

Studies that had looked at specific groups of patients, such as those with laryngopharyngeal complaints, have found mixed results. The overall prevalence of HGMP/CIP was in the similar range compared to studies that had been carried out on patients coming for routine endoscopy. One study that had looked specifically at patients with laryngopharyngeal reflux found significantly more HGMP/CIP in patients than controls, those without LPR symptoms (11.4% vs. 1.6%, *p*<0.05). These patients also had significantly more laryngeal acid reflux documented on pH study (Akbayir N. et al., 2004). Similarly, other studies have found more laryngopharyngeal reflux symptoms in patients with HGMP/CIP (Akbayir et al, 2004; Baudet et al., 2006; Borhan-Manesh & Franum, 1993; Tang et al., 2004). Another study looking at patients who had undergone fundoplications for gastroesophageal reflux with laryngeal reflux only found one patient (3.4%) to have HGMP/CIP (Salminen & Ovaska, 2009). This patient had a small HGMP/CIP and the authors concluded that HGMP/CIP does not have a significant role in laryngopharyngeal reflux in patients with

Unfortunately, all these studies have not inquired on the same symptoms complex and

Interestingly, only one study had assessed the size of HGMP/CIP on clinical symptoms and did not find significant differences (Chong & Jalihal, 2010). This study categorized HGMP/CIP to small/moderate (<15mm) and large (>15mm). Only cough was significantly more (50% vs. 8.3%, p=0.022) common in patients with larger patch. Interestingly, patients with smaller HGMP/CIP were found to have more globus and regurgitation. Several explanations were given for the lack of correlations between size of HGMP/CIP and

has also been shown to be associated with HGMP/CIP (Korkut et al., 2010).

gastroesophageal reflux disease.

hence make comparison difficult.
