How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

Nicola de Bortoli, Andrea Nacci, Edoardo Savarino, Irene Martinucci, Massimo Bellini, Bruno Fattori, Linda Ceccarelli, Francesco Costa, Maria Gloria Mumolo, Angelo Ricchiuti, Vincenzo Savarino, Stefano Berrettini, Santino Marchi

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

AIM: To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR). METHODS: Between May 2011 and October 2011, 41 consecutive patients with laryngopharyngeal symptoms (LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors (PPIs) for at least 8 wk, and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale, GIS; visual analogue scale, VAS). LPR diagnosis was performed by ear, nose and throat specialists using the reflux finding score (RFS) and reflux symptom index (RSI). After a 16-d wash-out from PPIs, all patients underwent an upper endoscopy, stationary esophageal manometry, 24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring. A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD), pathological acid exposure time (AET) in the absence of esophageal erosions (NERD), and a positive correlation between symptoms and refluxes (hypersensitive esophagus, HE). RESULTS: The male/female ratio was 0.52 (14/27), the mean age ± SD was 51.5 ± 12.7 years, and the mean body mass index was 25.7 ± 3.4 kg/m2. All subjects reported one or more LPS. Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation). The most frequent laryngoscopic findings were posterior laryngeal hyperemia (38/41), linear indentation in the medial edge of the vocal fold (31/41), vocal fold nodules (6/41) and diffuse infraglottic oedema (25/41). The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P <0.05); conversely, 23/41 did not report any clinical improvement. At the same time, the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy (P <0.001). A significant reduction in LPS symptoms. On the other hand, such result was not recorded for LPS. Esophagitis was detected in 2/41 patients, and ineffective esophageal motility was found in 3/41 patients. The MII-pH analysis showed an abnormal AET in 5/41 patients (2 ERD and 3 NERD); 11/41 patients had a normal AET and a positive association between symptoms and refluxes (HE), and 25/41 patients had a normal AET and a negative association between symptoms and refluxes (no GERD patients). It is noteworthy that HE patients had a positive association with typical GERD-related symptoms. Gas refluxes were found more frequently in patients with globus (29.7 ± 3.6) and hoarseness (21.5 ± 7.4) than in patients with heartburn or regurgitation (7.8 ± 6.2). Gas refluxes were positively associated with extraesophageal symptoms (P <0.05). Overall, no differences were found among the three groups of patients in terms of the frequency of laryngeal signs. The proximal reflux was abnormal in patients with ERD/NERD only. The differences observed by means of MII-pH analysis among the three subgroups of patients (ERD/NERD, HE, no GERD) were not demonstrated with the RSI and RFS. Moreover, only the number of gas refluxes was found to have a significant association with the RFS (P = 0.028 and P = 0.026, nominal and numerical correlation, respectively). CONCLUSION: MII-pH analysis confirmed GERD diagnosis in less than 40% of patients with previous diagnosis of LPR, most likely because of the low specificity of the laryngoscopic findings.

Original languageEnglish
Pages (from-to)4363-4370
Number of pages8
JournalWorld Journal of Gastroenterology
Volume18
Issue number32
DOIs
Publication statusPublished - 2012

Fingerprint

Laryngopharyngeal Reflux
Laryngoscopy
Gastroesophageal Reflux
Proton Pump Inhibitors
Electric Impedance
Esophagus
Heartburn
Acids
Esophagitis
Vocal Cords
Gases
Esophageal pH Monitoring

Keywords

  • Chronic laryngitis
  • Extra-esophageal reflux syndromes
  • Gastroesophageal reflux
  • Laryngopharyngeal reflux
  • Multichannel impedance and pH monitoring

ASJC Scopus subject areas

  • Gastroenterology

Cite this

de Bortoli, N., Nacci, A., Savarino, E., Martinucci, I., Bellini, M., Fattori, B., ... Marchi, S. (2012). How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related? World Journal of Gastroenterology, 18(32), 4363-4370. https://doi.org/10.3748/wjg.v18.i32.4363

How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related? / de Bortoli, Nicola; Nacci, Andrea; Savarino, Edoardo; Martinucci, Irene; Bellini, Massimo; Fattori, Bruno; Ceccarelli, Linda; Costa, Francesco; Mumolo, Maria Gloria; Ricchiuti, Angelo; Savarino, Vincenzo; Berrettini, Stefano; Marchi, Santino.

In: World Journal of Gastroenterology, Vol. 18, No. 32, 2012, p. 4363-4370.

Research output: Contribution to journalArticle

de Bortoli, N, Nacci, A, Savarino, E, Martinucci, I, Bellini, M, Fattori, B, Ceccarelli, L, Costa, F, Mumolo, MG, Ricchiuti, A, Savarino, V, Berrettini, S & Marchi, S 2012, 'How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?', World Journal of Gastroenterology, vol. 18, no. 32, pp. 4363-4370. https://doi.org/10.3748/wjg.v18.i32.4363
de Bortoli, Nicola ; Nacci, Andrea ; Savarino, Edoardo ; Martinucci, Irene ; Bellini, Massimo ; Fattori, Bruno ; Ceccarelli, Linda ; Costa, Francesco ; Mumolo, Maria Gloria ; Ricchiuti, Angelo ; Savarino, Vincenzo ; Berrettini, Stefano ; Marchi, Santino. / How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?. In: World Journal of Gastroenterology. 2012 ; Vol. 18, No. 32. pp. 4363-4370.
@article{10c02cdd84114afc8c56e5d123b6c022,
title = "How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?",
abstract = "AIM: To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR). METHODS: Between May 2011 and October 2011, 41 consecutive patients with laryngopharyngeal symptoms (LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors (PPIs) for at least 8 wk, and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale, GIS; visual analogue scale, VAS). LPR diagnosis was performed by ear, nose and throat specialists using the reflux finding score (RFS) and reflux symptom index (RSI). After a 16-d wash-out from PPIs, all patients underwent an upper endoscopy, stationary esophageal manometry, 24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring. A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD), pathological acid exposure time (AET) in the absence of esophageal erosions (NERD), and a positive correlation between symptoms and refluxes (hypersensitive esophagus, HE). RESULTS: The male/female ratio was 0.52 (14/27), the mean age ± SD was 51.5 ± 12.7 years, and the mean body mass index was 25.7 ± 3.4 kg/m2. All subjects reported one or more LPS. Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation). The most frequent laryngoscopic findings were posterior laryngeal hyperemia (38/41), linear indentation in the medial edge of the vocal fold (31/41), vocal fold nodules (6/41) and diffuse infraglottic oedema (25/41). The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P <0.05); conversely, 23/41 did not report any clinical improvement. At the same time, the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy (P <0.001). A significant reduction in LPS symptoms. On the other hand, such result was not recorded for LPS. Esophagitis was detected in 2/41 patients, and ineffective esophageal motility was found in 3/41 patients. The MII-pH analysis showed an abnormal AET in 5/41 patients (2 ERD and 3 NERD); 11/41 patients had a normal AET and a positive association between symptoms and refluxes (HE), and 25/41 patients had a normal AET and a negative association between symptoms and refluxes (no GERD patients). It is noteworthy that HE patients had a positive association with typical GERD-related symptoms. Gas refluxes were found more frequently in patients with globus (29.7 ± 3.6) and hoarseness (21.5 ± 7.4) than in patients with heartburn or regurgitation (7.8 ± 6.2). Gas refluxes were positively associated with extraesophageal symptoms (P <0.05). Overall, no differences were found among the three groups of patients in terms of the frequency of laryngeal signs. The proximal reflux was abnormal in patients with ERD/NERD only. The differences observed by means of MII-pH analysis among the three subgroups of patients (ERD/NERD, HE, no GERD) were not demonstrated with the RSI and RFS. Moreover, only the number of gas refluxes was found to have a significant association with the RFS (P = 0.028 and P = 0.026, nominal and numerical correlation, respectively). CONCLUSION: MII-pH analysis confirmed GERD diagnosis in less than 40{\%} of patients with previous diagnosis of LPR, most likely because of the low specificity of the laryngoscopic findings.",
keywords = "Chronic laryngitis, Extra-esophageal reflux syndromes, Gastroesophageal reflux, Laryngopharyngeal reflux, Multichannel impedance and pH monitoring",
author = "{de Bortoli}, Nicola and Andrea Nacci and Edoardo Savarino and Irene Martinucci and Massimo Bellini and Bruno Fattori and Linda Ceccarelli and Francesco Costa and Mumolo, {Maria Gloria} and Angelo Ricchiuti and Vincenzo Savarino and Stefano Berrettini and Santino Marchi",
year = "2012",
doi = "10.3748/wjg.v18.i32.4363",
language = "English",
volume = "18",
pages = "4363--4370",
journal = "World Journal of Gastroenterology",
issn = "1007-9327",
publisher = "WJG Press",
number = "32",

}

TY - JOUR

T1 - How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

AU - de Bortoli, Nicola

AU - Nacci, Andrea

AU - Savarino, Edoardo

AU - Martinucci, Irene

AU - Bellini, Massimo

AU - Fattori, Bruno

AU - Ceccarelli, Linda

AU - Costa, Francesco

AU - Mumolo, Maria Gloria

AU - Ricchiuti, Angelo

AU - Savarino, Vincenzo

AU - Berrettini, Stefano

AU - Marchi, Santino

PY - 2012

Y1 - 2012

N2 - AIM: To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR). METHODS: Between May 2011 and October 2011, 41 consecutive patients with laryngopharyngeal symptoms (LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors (PPIs) for at least 8 wk, and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale, GIS; visual analogue scale, VAS). LPR diagnosis was performed by ear, nose and throat specialists using the reflux finding score (RFS) and reflux symptom index (RSI). After a 16-d wash-out from PPIs, all patients underwent an upper endoscopy, stationary esophageal manometry, 24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring. A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD), pathological acid exposure time (AET) in the absence of esophageal erosions (NERD), and a positive correlation between symptoms and refluxes (hypersensitive esophagus, HE). RESULTS: The male/female ratio was 0.52 (14/27), the mean age ± SD was 51.5 ± 12.7 years, and the mean body mass index was 25.7 ± 3.4 kg/m2. All subjects reported one or more LPS. Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation). The most frequent laryngoscopic findings were posterior laryngeal hyperemia (38/41), linear indentation in the medial edge of the vocal fold (31/41), vocal fold nodules (6/41) and diffuse infraglottic oedema (25/41). The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P <0.05); conversely, 23/41 did not report any clinical improvement. At the same time, the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy (P <0.001). A significant reduction in LPS symptoms. On the other hand, such result was not recorded for LPS. Esophagitis was detected in 2/41 patients, and ineffective esophageal motility was found in 3/41 patients. The MII-pH analysis showed an abnormal AET in 5/41 patients (2 ERD and 3 NERD); 11/41 patients had a normal AET and a positive association between symptoms and refluxes (HE), and 25/41 patients had a normal AET and a negative association between symptoms and refluxes (no GERD patients). It is noteworthy that HE patients had a positive association with typical GERD-related symptoms. Gas refluxes were found more frequently in patients with globus (29.7 ± 3.6) and hoarseness (21.5 ± 7.4) than in patients with heartburn or regurgitation (7.8 ± 6.2). Gas refluxes were positively associated with extraesophageal symptoms (P <0.05). Overall, no differences were found among the three groups of patients in terms of the frequency of laryngeal signs. The proximal reflux was abnormal in patients with ERD/NERD only. The differences observed by means of MII-pH analysis among the three subgroups of patients (ERD/NERD, HE, no GERD) were not demonstrated with the RSI and RFS. Moreover, only the number of gas refluxes was found to have a significant association with the RFS (P = 0.028 and P = 0.026, nominal and numerical correlation, respectively). CONCLUSION: MII-pH analysis confirmed GERD diagnosis in less than 40% of patients with previous diagnosis of LPR, most likely because of the low specificity of the laryngoscopic findings.

AB - AIM: To investigate the prevalence of gastroesophageal reflux disease (GERD) in patients with a laryngoscopic diagnosis of laryngopharyngeal reflux (LPR). METHODS: Between May 2011 and October 2011, 41 consecutive patients with laryngopharyngeal symptoms (LPS) and laryngoscopic diagnosis of LPR were empirically treated with proton pump inhibitors (PPIs) for at least 8 wk, and the therapeutic outcome was assessed through validated questionnaires (GERD impact scale, GIS; visual analogue scale, VAS). LPR diagnosis was performed by ear, nose and throat specialists using the reflux finding score (RFS) and reflux symptom index (RSI). After a 16-d wash-out from PPIs, all patients underwent an upper endoscopy, stationary esophageal manometry, 24-h multichannel intraluminal impedance and pH (MII-pH) esophageal monitoring. A positive correlation between LPR diagnosis and GERD was supposed based on the presence of esophagitis (ERD), pathological acid exposure time (AET) in the absence of esophageal erosions (NERD), and a positive correlation between symptoms and refluxes (hypersensitive esophagus, HE). RESULTS: The male/female ratio was 0.52 (14/27), the mean age ± SD was 51.5 ± 12.7 years, and the mean body mass index was 25.7 ± 3.4 kg/m2. All subjects reported one or more LPS. Twenty-five out of 41 patients also had typical GERD symptoms (heartburn and/or regurgitation). The most frequent laryngoscopic findings were posterior laryngeal hyperemia (38/41), linear indentation in the medial edge of the vocal fold (31/41), vocal fold nodules (6/41) and diffuse infraglottic oedema (25/41). The GIS analysis showed that 10/41 patients reported symptom relief with PPI therapy (P <0.05); conversely, 23/41 did not report any clinical improvement. At the same time, the VAS analysis showed a significant reduction in typical GERD symptoms after PPI therapy (P <0.001). A significant reduction in LPS symptoms. On the other hand, such result was not recorded for LPS. Esophagitis was detected in 2/41 patients, and ineffective esophageal motility was found in 3/41 patients. The MII-pH analysis showed an abnormal AET in 5/41 patients (2 ERD and 3 NERD); 11/41 patients had a normal AET and a positive association between symptoms and refluxes (HE), and 25/41 patients had a normal AET and a negative association between symptoms and refluxes (no GERD patients). It is noteworthy that HE patients had a positive association with typical GERD-related symptoms. Gas refluxes were found more frequently in patients with globus (29.7 ± 3.6) and hoarseness (21.5 ± 7.4) than in patients with heartburn or regurgitation (7.8 ± 6.2). Gas refluxes were positively associated with extraesophageal symptoms (P <0.05). Overall, no differences were found among the three groups of patients in terms of the frequency of laryngeal signs. The proximal reflux was abnormal in patients with ERD/NERD only. The differences observed by means of MII-pH analysis among the three subgroups of patients (ERD/NERD, HE, no GERD) were not demonstrated with the RSI and RFS. Moreover, only the number of gas refluxes was found to have a significant association with the RFS (P = 0.028 and P = 0.026, nominal and numerical correlation, respectively). CONCLUSION: MII-pH analysis confirmed GERD diagnosis in less than 40% of patients with previous diagnosis of LPR, most likely because of the low specificity of the laryngoscopic findings.

KW - Chronic laryngitis

KW - Extra-esophageal reflux syndromes

KW - Gastroesophageal reflux

KW - Laryngopharyngeal reflux

KW - Multichannel impedance and pH monitoring

UR - http://www.scopus.com/inward/record.url?scp=84867731925&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867731925&partnerID=8YFLogxK

U2 - 10.3748/wjg.v18.i32.4363

DO - 10.3748/wjg.v18.i32.4363

M3 - Article

C2 - 22969200

AN - SCOPUS:84867731925

VL - 18

SP - 4363

EP - 4370

JO - World Journal of Gastroenterology

JF - World Journal of Gastroenterology

SN - 1007-9327

IS - 32

ER -