To the Editor:—

It is not uncommon for patients to complain of a “sore throat” after surgery that requires intubation. Despite variations in the degree of difficulty of intubation, there seems to be no correlation between attempts or duration of intubation and the degree (if any) of sore throat. In most instances, the patient makes the complaint immediately after surgery.

On occasion, however, the patient makes no comment until a few days after surgery. Despite the delay in onset of symptoms, this pharyngitis is still often blamed on the intubation process. However, there are other causes of inflammation that should be considered, chief among them gastroesophageal reflux disease (GERD).

We are report one such case in a patient with a history of reflux disease. A 58-yr-old man underwent excision of a renal tumor. The intubation and surgery were uneventful. On the fourth postoperative day, he complained of a severe sore throat, which persisted for many weeks. Initially, this was thought to be related to intubation. An otolaryngologist was consulted and a detailed examination was performed. This examination revealed no injuries related to intubation; however, it did show inflammation of the pharynx consistent with the changes seen in GERD. An endoscopy performed by gastroenterology also revealed an acute exacerbation of reflux disease. Once the patient was adequately treated, these symptoms disappeared in approximately 6 weeks.

GERD is being diagnosed with greater frequency today, and patients may be on oral antireflux medication preoperatively, such as Prilosec or nexium. These drugs are quite often discontinued in the immediate postoperative period. In addition, ileus is common postoperatively because of bowel manipulation intraoperatively, administration of intraoperative and postoperative narcotics, interstitial edema (third spacing), or a combination of these factors. Lack of ambulation further promotes ileus. Patients also tend to spend more time in the recumbent position. Repeated attempts to clear the throat because of the irritation will merely increase it.

GERD is now recognized as being fairly common in the general population, and more and more patients arriving for surgery give a history of some degree of GERD, whether being medically treated or not. As this is now recognized, and given the multitude of factors postoperatively that promote GERD, the anesthesiologist should consider this disease when visiting a patient with late-onset pharyngitis after surgery.