Impedance/pH-metry Findings in Patients with Laryngopharyngeal Reflux by Clinical Score

Background & Aim: Although micro-aspiration of gastric contents particularly acid reflux may be responsible for laryngopharyngeal reflux (LPR), half of the patients fail to respond to antisecretory therapy. The aims of this prospective study were to elucidate correlation between clinical score; reflux symptom index (RSI) and reflux finding score (RFS) and impedance/pH metry finding in LPR patients Methods: Sixty-three consecutive patients with signs and symptoms of chronic laryngitis and with clinical score (reflux symptom index (RSI) ≥ 13, or reflux finding score (RFS) ≥ 7) were enrolled. After 2-week cessation of acid-suppression medication, participants underwent monitoring of gastroesophageal reflux episodes using multichannel intraluminal impedance (MII) 24-hour pH testing. Results: There were 63 patients (44 females and 19 males), aged 48.6 ± 11.4 years (range 18- 74 years). The mean reflux symptom index (RSI) scores was 18.65 ± 6.0, and the mean reflux finding score (RFS) was 8.69 ± 3.6. Sixteen of 63 patients (25.4%) had pathological acid reflux. Based on the MII-pH results, 6.3% of patients had acid reflux while 15.9% had weakly acid reflux. Most patients had pure abnormal gas reflux (39.7%), 15.9% had abnormal mixed reflux, 20.6% had abnormal mixed and gas reflux and 23.8% had no reflux. Comparing RSI and RFS score with any types of refluxate, there were no differences in both RSI and RFS score between any types of refluxate, (p = 0.196 and p = 0.658), respectively. The most common presenting symptom in acid reflux and weakly acid reflux patients was globus sensation (60%, 85% respectively). In gas reflux, however, heartburn was rare (15%). Conclusion: The results from this study suggest that retrograde flow of gastric contents may be a cause of chronic laryngitic symptoms in LPR patients. RSI and RFS clinical scores were not helpful to discriminate the different types of reflux. The symptoms of heartburn and regurgitation were more with acid or weakly acid reflux than gas reflux. MII-pH monitoring could be helpful in further refinement of LPR treatment.