A study with pharyngeal and esophageal 24-hour pH–impedance monitoring in patients with laryngopharyngeal symptoms refractory to proton pump inhibitors

Abstract

Background

The role of gastroesophageal reflux in chronic laryngeal symptoms is difficult to establish. The aim of this study was to characterize pharyngeal and esophageal pH–impedance reflux patterns in a group of patients with suspected laryngopharyngeal reflux and to determine predictive factors of response to proton pump inhibitors.

Methods

Patients with chronic pharyngolaryngeal symptoms were evaluated with a symptom score questionnaire, laryngoscopy, and 24-hour pharyngeal and esophageal pH–impedance monitoring at baseline and after 8-week treatment with esomeprazole 40 mg b.i.d. Response to treatment was defined by a diminution of more than 50% of the score for the primary symptom. Reflux patterns and baseline impedance values were compared to those obtained in 46 healthy subjects.

Key Results

Twenty-four patients were included (17 women, median age 54 years), all previously refractory to antisecretory therapy. Symptom scores were 46 (32–62) and 40 (27–76) off and on therapy, respectively (P=.1). There was no significant difference between patients and controls for pH–impedance reflux parameters and baseline values off and on therapy in distal and proximal esophagus and in the pharynx. Median numbers of pharyngeal reflux were 0 and 0 off and on therapy, respectively. Only two patients were responders to treatment, both with excessive distal reflux but no pharyngeal reflux. Only one patient had abnormal pharyngeal reflux but did not respond to proton pump inhibitors.

Conclusions

Patients with suspected laryngopharyngeal reflux refractory to therapy do not exhibit abnormal pharyngeal or esophageal pH–impedance reflux. In these patients, laryngopharyngeal reflux is unlikely.

The role of gastroesophageal reflux in chronic laryngeal symptoms is difficult to establish. This prospective study shows that patients with suspected laryngopharyngeal reflux refractory to therapy do not exhibit abnormal pharyngeal or esophageal pH–impedance reflux. In these patients, laryngopharyngeal reflux is unlikely and has been largely overestimated.

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