Anatomy of reflux: A growing health problem affecting structures of the head and neck


  • Michael J. Lipan,

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    • Dr. Lipan has recently graduated with an MD with distinction in research from Mount Sinai School of Medicine (MSSM), New York, and has begun an otolaryngology residency at Jackson Memorial Hospital in Miami, Florida. He has frequently presented aspects of his research findings on the anatomical underpinnings of gastroesophageal reflux disease and laryngopharyngeal reflux at meetings of the American Association of Anatomists (AAA) and the Association for Research in Otolaryngology.

  • Joy S. Reidenberg,

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    • Dr. Reidenberg is associate professor of anatomy and functional morphology and associate professor of medical education at MSSM. She is a recognized expert in the comparative biology of mammalian throats, with a particular interest in cetaceans. She was the 1999 recipient of the Basmajian-Williams and Wilkins Award of the AAA for excellence in teaching and research by a gross anatomist.

  • Jeffrey T. Laitman

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    • Mount Sinai School of Medicine, Center for Anatomy and Functional Morphology, Box 1007, New York, NY 10029
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    • Dr. Laitman is a distinguished professor at MSSM, professor and director of the Center for Anatomy and Functional Morphology, professor of otolaryngology and of medical education. He is a member of the AAA Board of Directors. His research has focused on elucidating the distinctive developmental and evolutionary features of the human aerodigestive tract and how these may relate to human disease. In 1997, Drs. Laitman and Reidenberg advanced the theory that the particularly low position in the neck of the human larynx was the anatomical basis allowing for reflux of gastric material into portals of the head and neck.

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Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) are sibling diseases that are a modern-day plague. Millions of Americans suffer from their sequelae, ranging from subtle annoyances to life-threatening illnesses such as asthma, sleep apnea, and cancer. Indeed, the recognized prevalence of GERD alone has increased threefold throughout the 1990s. Knowledge of the precise etiologies for GERD and LPR is becoming essential for proper treatment. This review focuses on the anatomical, physiological, neurobiological, and cellular aspects of these diseases. By definition, gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus; when excessive and damaging to the esophageal mucosa, GERD results. Reflux that advances to the laryngopharynx and, subsequently, to other regions of the head and neck such as the larynx, oral cavity, nasopharynx, nasal cavity, paranasal sinuses, and even middle ear results in LPR. While GERD has long been identified as a source of esophageal disease, LPR has only recently been implicated in causing head and neck problems. Recent research has identified four anatomical/physiological “barriers” that serve as guardians to prevent the cranial incursion of reflux: the gastroesophageal junction, esophageal motor function and acid clearance, the upper esophageal sphincter, and pharyngeal and laryngeal mucosal resistance. Sequential failure of all four barriers is necessary to produce LPR. While it has become apparent that GER must precede both GERD and LPR, the head and neck distribution of the latter clearly separates these diseases as distinct entities warranting specialized focus and treatment. Anat Rec (Part B: New Anat) 289B:261–270, 2006. © 2006 Wiley-Liss, Inc.