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Acidic Pharyngeal Reflux Does Not Correlate with Symptoms and Laryngeal Injury Attributed to Laryngopharyngeal Reflux

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Abstract

Background

Laryngopharyngeal reflux (LPR) is suspected when the symptoms are attributed to the penetration of acidic gastroesophageal reflux (GER) into the larynx. However, the relationships between the intensity of LPR and symptoms and laryngeal injury have not been elucidated. Several factors confound the study of LPR, namely pH is monitored in the pharynx (pharyngeal reflux) but the pharyngeal acidity (pH) required to induce laryngeal injury is unknown, the GER origin of pharyngeal acid is not always established, and a recent treatment with proton pump inhibitors (PPI) confounds the analysis.

Aims

We aimed to limit these confounding factors to analyze the relationship between LPR and symptoms and laryngeal injury.

Methods

We used dual pharyngeal and distal esophageal 24-h pH/impedance monitoring to establish GER origin of pharyngeal reflux, we used an unbiased approach to analysis by evaluating a whole range of acidity (pH < 6, pH < 5.5, pH < 5.0, pH < 4.5 and pH < 4.0) in patients with suspected LPR without PPI for  > 30 days.

Results

Pharyngeal reflux was (median[IQR]) 14[8–20.5] and 4[1.5–6.5] pharyngeal reflux episodes with pH < 6.0 and pH < 5.5, respectively. Pharyngeal reflux with pH < 5.0 was rare. Comprehensive analysis did not reveal any correlation between symptoms (reflux symptom index) or laryngeal injury (reflux finding score) and the number of pharyngeal reflux episodes or duration of pharyngeal acid exposure at any pH level.

Conclusion

Unbiased comprehensive approach did not reveal any relationship between acidic pharyngeal reflux and the symptoms or laryngeal injury attributed to LPR. Limited clinical usefulness of pharyngeal monitoring reported by others is unlikely due to confounding factors.

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Funding

This study was supported by VEGA 1/0513/18 (Department of Education, Slovakia). This study is the result of the project implementation: Completion of the Centre of Experimental and Clinical Respirology II, ITMS code of Project: 26220120034. MK was partially supported by NIH R01 DK110366 (PI-MK).

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Authors and Affiliations

  1. Gastroenterology Clinic JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Kollárova 2, 03659, Martin, Slovakia

    Martin Duricek, Peter Banovcin & Rudolf Hyrdel

  2. Clinic of ENT and Head and Neck Surgery, Central Military and Faculty Hospital in Ružomberok, Považská 1380/2, 034 01, Ružomberok, Slovakia

    Tatiana Halickova

  3. Department of Pathophysiology JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Ružomberok, Slovakia

    Marian Kollarik

  4. Department of Molecular Pharmacology & Physiology, University of South Florida, Tampa, FL, USA

    Marian Kollarik

Authors
  1. Martin Duricek
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  2. Peter Banovcin
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  3. Tatiana Halickova
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  4. Rudolf Hyrdel
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  5. Marian Kollarik
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Contributions

MD enrolled patients, performed manometry, pH/impedance monitoring, administered questionnaires, analyzed manometry, pH/impedance studies, analyzed data, and cowrote the manuscript. PB performed manometry, pH/impedance monitoring, and analyzed manometry. TH performed flexible laryngoscopy and evaluated reflux finding score. RH analyzed manometry. MK formulated hypotheses, analyzed data, and cowrote the manuscript.

Corresponding author

Correspondence to Peter Banovcin.

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The authors declare that they have no conflict of interest.

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Duricek, M., Banovcin, P., Halickova, T. et al. Acidic Pharyngeal Reflux Does Not Correlate with Symptoms and Laryngeal Injury Attributed to Laryngopharyngeal Reflux. Dig Dis Sci 64, 1270–1280 (2019). https://doi.org/10.1007/s10620-018-5372-1

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  • DOI: https://doi.org/10.1007/s10620-018-5372-1

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