Introduction
Laryngopharyngeal Reflux (LPR) is a common troublesome complaint in clinical practice. The treatment outcomes were unsatisfied given unclear pathophysiology and lack of gold standard test. Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) had been used to help with the diagnosis while esophageal multichannel intraluminal impedance (MII)/pH monitoring is the most reliable tool to evaluate gastroesophageal reflux disease (GERD). The role of MII/pH monitoring in extra-esophageal GERD is controversial.
Aims & Methods
We aimed to evaluate the benefit of MII/pH monitoring results in patients with LPR defined by clinical scoring of RSI ≥ 13 points and/or RFS ≥ 7 points.
Patients with definite LPR diagnosed by otolaryngologists using predefined RSI and RFS were recruited. All participants underwent esophageal manometry and off-PPI MII/pH monitoring. The results of MII/pH findings and clinical scores were determined for the correlation.
Results
A total of 100 (71 Female, 29 Men) LPR patients were enrolled, with the mean age of 50.1 years. The mean RSI and RSF score were 18.4±6.1 and 9.8±4.1 respectively. Half of the patients had abnormal manometry; 48% had ineffective esophageal motility (IEM) and 9% had low lower esophageal sphincter pressure (LESP). The median acid exposure time (AET) was 1.85% and the median number of reflux episodes and proximal reflux episodes were 29.5 and 4 respectively.Gas reflux is the most common type of reflux with 98% of population. There was a significant correlation between RSI and the number of gas reflux (r = 0.255, P-value 0.011). There was no difference in RSI and RFS in all MII/pH parameter subgroups, including pathological vs non-pathological acid reflux, a high vs low DeMeester score, a high vs low number of reflux, proximal reflux, or acid reflux.
Correlation between RSI or RFS and MII/pH finding
| Parameters | RSI | RFS |
| r | P-value | r | P-value |
| Acid exposure time | 0.016 | 0.877 | -0.149 | 0.244 |
| No. of reflux events | 0.026 | 0.794 | -0.027 | 0.835 |
| No. of proximal reflux events | 0.017 | 0.867 | -0.174 | 0.172 |
| No. of acid reflux events | 0.041 | 0.688 | -0.147 | 0.250 |
| No. of nonacid reflux events | 0.021 | 0.833 | -0.045 | 0.727 |
| No. of liquid reflux events | 0.041 | 0.683 | 0.201 | 0.115 |
| No. of gas reflux events | 0.255 | 0.011 | -0.078 | 0.541 |
| No. of mixed reflux events | 0.136 | 0.176 | 0.201 | 0.115 |
MII; Multichannel Intraluminal Impedance, RFI; reflux finding score, RSI; reflux symptom index
Conclusion
In this population, there were no significant acid refluxes in patients with LPR diagnosed by standard cut-off score of RSI and/or RFS. However, RSI had significant correlation with gas reflux episodes. Interestingly, up to 60% of the participants had IEM or low LESP. These findings are still be scrutinized.
References
1. Vaezi, M.F., et al., Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. Clin Gastroenterol Hepatol, 2003. 1(5): p. 333-44.
2. Belafsky, P.C., G.N. Postma, and J.A. Koufman, Validity and reliability of the reflux symptom index (RSI). J Voice, 2002. 16(2): p. 274-7.
3. Belafsky, P.C., G.N. Postma, and J.A. Koufman, The validity and reliability of the reflux finding score (RFS). Laryngoscope, 2001. 111(8): p. 1313-7.
4. Ahmed, T. and M.F. Vaezi, The role of pH monitoring in extraesophageal gastroesophageal reflux disease.Gastrointest Endosc Clin N Am, 2005. 15(2): p. 319-31.
5. Joniau, S., et al., Reflux and laryngitis: a systematic review. Otolaryngol Head Neck Surg, 2007. 136(5): p. 686-92.
6. Chang, B.A., et al., The Reliability of the Reflux Finding Score Among General Otolaryngologists. J Voice, 2015. 29(5): p. 572-7.
