792 Loss of Alkalization in Proximal Esophagus: A New Diagnostic Paradigm for Patients With Laryngopharyngeal Reflux
Shahin AyaziJeffrey A. HagenJoerg ZehetnerMatthew LilleyPriyanka WaliFlorian AugustinJohn C. LiphamSteven R. DeMeesterTom R. DeMeester
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Laryngopharyngeal Reflux
To evaluate the usefulness of gastroesophageal reflux disease questionnaire (GerdQ) and reflux symptom index (RSI) for diagnosis of gastroesophageal reflux disease (GERD) in patients with suspected laryngopharyngeal reflux (LPR) symptoms (cough, hoarseness, globus, and throat pain).A total of 98 patients with LPR symptoms were incorporated from either gastroenterology or otorhinolaryngology clinic. Patient's laryngoscopic findings were graded by reflux finding score (RFS), and RFS ≥ 7 was considered as positive LPR. Erosive esophagitis on endoscopy or abnormal results on ambulatory impedance-pH monitoring were used as diagnostic criteria for GERD. Esophageal motor function was evaluated using high-resolution esophageal manometry.Ninety-three (94.9%) of the 98 subjects were diagnosed as LPR by RFS, but only 15 (15.3%) had GERD. For GerdQ, the cutoff value of 9 showed the highest area under curve (AUC) to diagnose GERD by receiver operating curve analysis (AUC = 0.565); the sensitivity, specificity, positive predictive value, and negative predictive value were unsatisfactory (50.0%, 70.7%, 22.6%, and 89.2%, respectively.) RSI also showed poor performance in diagnosing GERD; the cutoff value of 25 showed the highest yield (AUC = 0.581); the sensitivity, specificity, positive predictive value, and negative predictive value were 42.9%, 79.3%, 26.1%, and 89.0%, respectively. Ineffective esophageal motility was frequently observed (69 of 98, 70.4%), but there was no difference in esophageal motility parameters between GERD and non-GERD patients.In patients with LPR symptoms, significant discrepancies are observed between laryngoscopic diagnosis and GERD. In this population, neither GerdQ nor RSI is useful in diagnosing GERD.
Laryngopharyngeal Reflux
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인早두역류(laryngopharyngeal reflux: LPR)은 위 산을 포함한 위내용물이 식도를 지나 상식도괄약근(upper esophageal sphincter: UES)보다 상부로 역류하 는 현상을 지칭하며 이로 인한 인후부와 성대의 자극에 의해 발생하는 증상군을 인후두역류증(laryngopharyn-geal reflux disease: LPRD)이라 한다.1,2) LPR은 위내 용물의 식도를 통한 역류를 의미하므로 넓게는 위식도역 류 질환(gastro-esophageal reflux disease: GERD) 의 범주에 속하고 있다.
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Objective: The study aimed to determine the utility of reflux finding score (RFS) and reflux symptom index (RSI) in diagnosis of laryngopharyngeal reflux disease (LPRD) in Dar es Salaam, Tanzania Design: Hospital based descriptive cross sectional study. Participants: Patients with throat and voice complaints for more than a month provided they have no other underlying cause such as tumors of the aerodigestive system or chronic irritants of the larynx such as cigarette smoking or those with misuse of voice such as choir singers, teachers. Main outcome measures: Statistical analyses described the utility of RFS and RSI in diagnosis of LPRD as designed by Belafsky et al where the diagnosis of reflux was made when the patient had an aggregate RSI score >13. Results: In this study, a total of 2500 patients were recruited, out of which 800 (32.0%) were males and 1700 (68.0%) were female. Out of the 2500, 1520 (60.8%) patients were found to have a RSI of >13. Out of the 1520 patients subjected to 70-degree laryngoscopy, 1425 patients (95.0%) were found to have a RFS >7. Of the 1425 patients with RFS >7, 260 were males (18.2%) and 1165 were females (81.8%). Conclusion: RFS and RSI have shown utility in diagnosing LPRD and they remain to be applicable even in resource-limited settings. There should be universal treatment protocol for LPRD since it vary among countries and health systems
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Objective: To compare the clinical characteristics of patients with different type of laryngopharyngeal reflux disease in order to study the effect of non-acid reflux on laryngopharyngeal reflux disease. Methods: From January 2015 to January 2020, 349 inpatients or outpatients suspected of having laryngopharyngeal reflux underwent 24-hour multichannel intraluminal impedance pH monitoring (MII-pH). There were 303 male and 46 female patients, with an average age of 56.03 years old ranged from 25 to 81 years old. The reflux symptom index (RSI)and reflux findings score(RFS)were recorded before MII-pH monitoring. The number of acid reflux events and non-acid reflux events in hypopharynx were counted. It was defined mainly acid reflux type when the ratio of acid reflux to all reflux events was greater than 50%, mainly non-acid reflux type when the ratio of non-acid reflux to all reflux events was greater than 50%. The clinical characteristics of patients with different type of reflux were compared. SPSS 19.0 software was used for statistical analysis, and multiple independent samples were compared between groups. The quantitative data were analyzed by multivariate analysis of variance, and the counting data were analyzed by chi-square test, the difference was statistically significant when P<0.05. Results: The 24-hour MII-pH showed that there were 90 patients with no reflux events, 51 patients with mainly acid reflux type, 198 patients with mainly non-acid reflux type and 10 patients with equal acid reflux events and non-acid reflux events. Statistics showed that the RSI(10.72±4.40), RFS(7.70±2.73) and the average number of reflux events(0) in the group without reflux events were significantly lower than those in patients with mainly acid reflux type (RSI 13.16±6.62,RFS 10.08±3.03,average number of reflux events 5.33±3.15,P<0.05) and mainly non-acid reflux type(RSI 13.25±5.54,RFS 8.81±2.54,average number of reflux events 7.93±5.26, P<0.05). There was no significant difference in RSI between the mainly non-acid reflux type group and the mainly acid reflux type group, but the RFS of the mainly non-acid reflux type group was significantly lower than that of the mainly acid reflux type group. The average number of reflux events in the mainly non-acid reflux group was significantly higher than that in the mainly acid reflux type group (P<0.05). Conclusion: The results show that non-acid reflux plays a certain role in laryngopharyngeal reflux disease, but the effect of acid reflux is greater.
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Aim:The aim of our study was to diagnose laryngopharyngeal reflux (LPR) by scoring systems developed by Belafsky and to see the effect of antireflux treatment in treating laryngopharyngeal reflux.Materials and methods: A prospective study was conducted at a Tertiary Care Hospital on 100 patients.Detailed history and complete examination of patient with GERD followed by flexible fiber optic endoscopy to diagnose LPR by reflux symptom index (RSI) and reflux finding score (RFS) scoring and then improvement at 4 and 8 weeks with treatment was done.Results: In our study, 10 cases showed improvement from 0 to 4 weeks and 23 cases from 4 to 8 weeks after treatment in RSI score.In total 33 cases showed improvement after 8 weeks.In RFS, 20 cases showed improvement from 0 to 4 weeks and 22 cases showed improvement from 4 to 8 weeks after treatment.In total 42 cases showed improvement after 8 weeks.Conclusion: From our study, we concluded that LPR was assessed by using RSI and RFS scoring systems.Patients with LPR showed improvement after treatment over weeks.Clinical significance: Through this study, we can easily make the diagnosis of LPR by scoring systems and see the effectiveness of PPI in the treatment of LPR.
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