Abstract :
Background & Aim: Although micro-aspiration of gastric contents particularly acid reflux may be
responsible for laryngopharyngeal reflux (LPR), some patients fail to respond to antisecretory therapy. The aims of
this prospective study were to elucidate evidence of gastric reflux and its correlation with esophageal injury in
nonresponder patients.
Methods: Forty-seven consecutive patients, who had signs and symptoms of chronic laryngitis and
were refractory to at least 3-months empirical therapy with proton pump inhibitors, were enrolled. After cessation
of acid-suppression medication for 2 weeks, all participants underwent upper gastrointestinal magnified narrow
band endoscopy with esophageal biopsies followed by monitoring of gastroesophageal reflux episodes using multichannel
intraluminal impedance (MII) 24-hour pH testing.
Results: Patients had a mean age of 48 ± 10 years; 81% were female; and mean body mass index was 22.3
± 3.1 kg/m2. At screening visit, 70% of patients reported symptoms of globus pharyngeus, 60% noted clearing
throat, 60% had regurgitation, 53% reported heartburn and 40% developed hoarseness. Mean reflux symptom
index (RSI) scores was 13 ± 7.9. Based on the MII-pH results, 409 liquid containing reflux events were recorded
in 45 patients and 1,615 gas reflux events were detected in 28 patients. Among the cohorts with liquid reflux
events, 11 patients (23%) were considered to have classic acid-reflux disease, 8 had “weakly acid” reflux episodes
and 2 had “weakly alkaline” reflux episodes. Patients with classic acid-reflux disease were more often male (45%
vs 11%, p = 0.02) and active alcoholic drinkers (27% vs 3%, p = 0.04) when compared to those without classic acidreflux
disease. Clinical characteristics including age, body mass index, history of smoking, laryngeal and gastroesophageal
symptoms, the RSI scores, and duration of antisecretory therapy were similar between two groups. With
white light endoscopy, erosive esophagitis were identified in only 2 patients documented to have classic acid-reflux
disease on MII-pH testing. Subsequently, the magnified narrow-band imaging system was used to enhance visualization
of esophageal mucosa. Non-erosive esophagitis was detected and confirmed by histology in 5 patients with
classic acid-reflux disease, 3 patients with “weakly acid” reflux, 1 patient with “weakly alkaline” reflux, and 6
patients with gas reflux.
Conclusions: This study suggested that retrograde flow of gastric contents might be a cause of chronic
laryngitic symptoms in some patients who do not respond to empirical antisecretory therapy. |
file/Thai-Journal-of-gastroenterology-vol-11-no-2-3105277.pdf