Clin Exp Otorhinolaryngol.  2018 Jun;11(2):141-145. 10.21053/ceo.2017.00577.

Comparison of Characteristics According to Reflux Type in Patients With Laryngopharyngeal Reflux

• Lee JS
• Jung AR
• Park JM
• Park MJ
• Lee YC
• Eun YG

• KMID: 2412672
• DOI: http://doi.org/10.21053/ceo.2017.00577

Abstract

OBJECTIVES
To analyze laryngopharyngeal reflux (LPR) as an acidic, nonacidic, or mixed type according to 24-hour multi-channel intraluminal impedance (MII) pH monitoring and the clinical characteristics of each type.
METHODS
Ninety patients were prospectively enrolled in this study. All patients underwent 24-hour MII pH monitoring as a diagnostic tool. Eighty-three patients were diagnosed with LPR. The patients were classified into three groups according to the pH of the hypopharyngeal probe: the acid reflux group, nonacid reflux group, and mixed reflux group. Subjective symptoms and objective findings were evaluated based on patients' responses to the Short Form 12 Survey (SF-12), LPR health-related quality of life (LPR-HRQOL), reflux symptom index, and reflux finding score.
RESULTS
The results of each group were compared. As a result, 34 patients were classified into the nonacid reflux group and 49 into the mixed reflux group. There were no patients classified as having acid reflux alone. There was no significant difference between the two groups when comparing the reflux symptom index, reflux finding score, LPR-HRQOL, or the mental component score of the SF-12. However, the physical component score of the SF-12 was higher in the nonacid reflux group (P=0.018). The DeMeester composite score (P=0.015) and total number of LPR events (P=0.001) were lower in the nonacid reflux group than in the mixed reflux group.
CONCLUSION
In conclusion, no LPR patient had only acid reflux. The nonacid reflux LPR patients showed similar clinical characteristics and findings compared to the mixed reflux group, but exhibited significantly fewer LPR episodes.

Keyword

Laryngopharyngeal Reflux; Reflux Type; 24-Hour Multichannel Intraluminal Impedance pH Monitoring

MeSH Terms

Electric Impedance
Humans
Hydrogen-Ion Concentration
Laryngopharyngeal Reflux*
Prospective Studies
Quality of Life

Figure

• 

  Fig. 1. Flow chart of this study. MII, multichannel intraluminal impedance; LPR, laryngopharyngeal reflux.

Reference

1. Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg. 2002; Jul. 127(1):32–5.

2. Hicks DM, Ours TM, Abelson TI, Vaezi MF, Richter JE. The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers. J Voice. 2002; Dec. 16(4):564–79.

3. Hoppo T, Sanz AF, Nason KS, Carroll TL, Rosen C, Normolle DP, et al. How much pharyngeal exposure is “normal”? Normative data for laryngopharyngeal reflux events using hypopharyngeal multichannel intraluminal impedance (HMII). J Gastrointest Surg. 2012; Jan. 16(1):16–24.

4. Sifrim D, Castell D, Dent J, Kahrilas PJ. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut. 2004; Jul. 53(7):1024–31.

5. Ford CN. Evaluation and management of laryngopharyngeal reflux. JAMA. 2005; Sep. 294(12):1534–40.

6. Armstrong D, Pare P, Pericak D, Pyzyk M, Canadian Pantoprazole GERD Study Group. Symptom relief in gastroesophageal reflux disease: a randomized, controlled comparison of pantoprazole and nizatidine in a mixed patient population with erosive esophagitis or endoscopy-negative reflux disease. Am J Gastroenterol. 2001; Oct. 96(10):2849–57.

7. Meineche-Schmidt V, Juhl HH, Ostergaard JE, Luckow A, Hvenegaard A. Costs and efficacy of three different esomeprazole treatment strategies for long-term management of gastro-oesophageal reflux symptoms in primary care. Aliment Pharmacol Ther. 2004; Apr. 19(8):907–15.

8. Storr MA. What is nonacid reflux disease? Can J Gastroenterol. 2011; Jan. 25(1):35–8.

9. Belafsky PC, Postma GN, Koufman JA. The validity and reliability of the reflux finding score (RFS). Laryngoscope. 2001; Aug. 111(8):1313–7.

10. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996; Mar. 34(3):220–33.

11. Carrau RL, Khidr A, Gold KF, Crawley JA, Hillson EM, Koufman JA, et al. Validation of a quality-of-life instrument for laryngopharyngeal reflux. Arch Otolaryngol Head Neck Surg. 2005; Apr. 131(4):315–20.

12. Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the reflux symptom index (RSI). J Voice. 2002; Jun. 16(2):274–7.

13. Lee BE, Kim GH, Ryu DY, Kim DU, Cheong JH, Lee DG, et al. Combined dual channel impedance/pH-metry in patients with suspected laryngopharyngeal reflux. J Neurogastroenterol Motil. 2010; Apr. 16(2):157–65.

14. Potluri S, Friedenberg F, Parkman HP, Chang A, MacNeal R, Manus C, et al. Comparison of a salivary/sputum pepsin assay with 24-hour esophageal pH monitoring for detection of gastric reflux into the proximal esophagus, oropharynx, and lung. Dig Dis Sci. 2003; Sep. 48(9):1813–7.

15. Portnoy JE, Gregory ND, Cerulli CE, Hawkshaw MJ, Lurie D, Katz PO, et al. Efficacy of super high dose proton pump inhibitor administration in refractory laryngopharyngeal reflux: a pilot study. J Voice. 2014; May. 28(3):369–77.

16. Lee YS, Choi SH, Son YI, Park YH, Kim SY, Nam SY. Prospective, observational study using rabeprazole in 455 patients with laryngopharyngeal reflux disease. Eur Arch Otorhinolaryngol. 2011; Jun. 268(6):863–9.

17. Xu X, Yu L, Chen Q, Lv H, Qiu Z. Diagnosis and treatment of patients with nonacid gastroesophageal reflux-induced chronic cough. J Res Med Sci. 2015; Sep. 20(9):885–92.

18. Niimi A, Torrego A, Nicholson AG, Cosio BG, Oates TB, Chung KF. Nature of airway inflammation and remodeling in chronic cough. J Allergy Clin Immunol. 2005; Sep. 116(3):565–70.

19. Patterson N, Mainie I, Rafferty G, McGarvey L, Heaney L, Tutuian R, et al. Nonacid reflux episodes reaching the pharynx are important factors associated with cough. J Clin Gastroenterol. 2009; May-Jun. 43(5):414–9.

20. Oelschlager BK, Quiroga E, Isch JA, Cuenca-Abente F. Gastroesophageal and pharyngeal reflux detection using impedance and 24-hour pH monitoring in asymptomatic subjects: defining the normal environment. J Gastrointest Surg. 2006; Jan. 10(1):54–62.