Hypopharyngeal-Esophageal Multichannel Intraluminal Impedance-pH Monitoring of LPR Patients May Affect Therapeutic Strategies

What is the profile of patients with laryngopharyngeal reflux (LPR) at hypopharyngeal-esophageal multichannel intraluminal impedance-pH (HEMII-pH) monitoring, and what is the relationship between hypopharyngeal-proximal reflux episodes (HREs) and saliva pepsin concentration?

BOTTOM LINE: Hypopharyngeal-proximal reflux episodes occur less frequently than gastroesophageal reflux disease episodes after meals and at night, and future therapies for LPR patients should take the HEMII-pH profile into consideration.

BACKGROUND: LPR is an inflammatory condition related to the effect of gastroduodenal content reflux. The development of LPR symptoms and signs is related to HREs, which can be detected by the use of HEMII-pH monitoring; however, HEMII-pH is infrequently used by most American and European otolaryngologists.

STUDY DESIGN: Prospective non-controlled study.

SETTING: Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital Centers Brussels, University Hospital Centers Saint-Pierre, School of Medicine, Free University of Brussels, Belgium.

SYNOPSIS: Researchers recruited 126 patients with LPR symptoms from three different hospitals who were seen between January 2018 and October 2019. Using HEMII-pH monitoring to confirm LPR diagnosis, physicians analyzed isolated reflux episodes at seven time points throughout the 24-hour monitoring period. To study the relationship between HEMII-pH episodes and saliva pepsin concentrations, patients collected saliva samples one to two hours after lunch and dinner, and in the morning (fasting). Symptoms and findings were assessed with Reflux Symptoms Scores and Reflux Sign Assessment, respectively. Researchers found the high majority of both acid and nonacid HREs occurred outside 60 minutes after mealtime, in daytime, and while patients were upright. Patients with night-time and recumbent HREs, more commonly associated with a GERD pattern, had more severe HEMII-pH parameters and symptom scores. Authors note that the identification of these two profile types of LPR patients may lead to an improvement of therapeutic schemes, including proton-pump inhibitor reduction. There was no significant positive association between HRE occurrences and saliva pepsin concentration in either group.

CITATION: Lechien JR, Bobin F, Dapri G, et al. Hypopharyngeal-esophageal impedance-pH monitoring profiles of laryngopharyngeal reflux patients [published online ahead of print May 21, 2020]. Laryngoscope. doi:10.1002/lary.28736.