Observations of increased gastroesophageal reflux symptomology in an anhydrous ammonia exposed population

Andrew C Elton; Erik P Severson; Frank G Ondrey; David A Opperman

doi:10.1016/j.amjoto.2022.103604

Observations of increased gastroesophageal reflux symptomology in an anhydrous ammonia exposed population

Am J Otolaryngol. 2022 Sep-Oct;43(5):103604. doi: 10.1016/j.amjoto.2022.103604. Epub 2022 Aug 10.

Authors

Andrew C Elton¹, Erik P Severson², Frank G Ondrey³, David A Opperman²

Affiliations

¹ University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA. Electronic address: elton024@umn.edu.
² Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA.
³ University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA; Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA.

PMID: 35981434
DOI: 10.1016/j.amjoto.2022.103604

Abstract

Objective: This case series describes a cohort of patients exposed to anhydrous ammonia vapors with clinical findings of laryngopharyngeal reflux (LPR). The study characterizes the identification of LPR as a consequence of vapor inhalation and the utility of PPI therapy in LPR secondary to inhalational ammonia exposure.

Methods: This is a case series of 15 patients exposed to anhydrous ammonia from a single chemical spill who experienced LPR several months after exposure. Symptoms of LPR were assessed at their initial consultation and by phone at least 30 days after treatment with low-dose PPI or diet modification. At this visit, patients underwent complete head and neck examination and flexible direct laryngoscopy.

Results: 15 patients were available for analysis before and after treatment. 93.3 % experienced at least three cardinal symptoms of LPR. 66 % of these patients had at least one LPR finding on flexible laryngoscopy. 73 % were treated with daily standard dose PPI, and 82 % of these patients experienced reduction of symptoms after 30 days of PPI treatment. Four of 15 patients were not taking the PPI as prescribed, and only one of these patients had resolution of LPR symptoms.

Conclusion: We conclude that there is an association between anhydrous ammonia exposure and the development of LPR symptoms. In this study, treatment with PPIs was successful in reducing symptoms for most patients, and patients who did not receive PPIs experienced symptoms for a longer time.

Keywords: Airway; Anhydrous ammonia; Gastroesophageal reflux.

MeSH terms

Ammonia* / therapeutic use
Cohort Studies
Humans
Laryngopharyngeal Reflux* / diagnosis
Laryngopharyngeal Reflux* / drug therapy
Laryngoscopy
Proton Pump Inhibitors / adverse effects

Substances

Proton Pump Inhibitors
Ammonia