Gastroesophageal reflux in patients with laryngeal disorders

The aim of this study is to use anamnesis and laryngeal examination to investigate the occurrence of the gastroesophageal reflux disease GERD (with symptoms of regurgitation and heartburn, signs of oesophagitis, and pathological pH monitoring) among patients with suspected laryngopharyngeal reflux.

One hundred and sixty-nine patients with laryngopharyngeal reflux indicated by anamnesis and laryngeal examination were evaluated retrospectively with endoscopy and 24-hour double-probe pH monitoring.

Combining endoscopy and pH monitoring made possible a diagnosis of GERD in 130 patients (77%). Of these patients, 58% had erosive oesophagitis and 84% had pathological oesophageal acid exposure. Of the patients with suspected laryngopharyngeal reflux and with established GERD, 49% reported gastrointestinal symptoms like heartburn or acid regurgitation. Erosive oesophagitis was confirmed in 45% of patients: grade 1 in 60 (35%), grade 2 in 10 patients (6%), and grades 3 and 4 in 3 patients each (2%). Distal oesophageal pH monitoring was pathological in 65% of patients. Of these, 93% had upright pathological acid exposure. Proximal oesophageal acid exposure was pathological in 39% of patients.

Reflux can be suspected when a patient presents typical laryngeal symptoms and signs. The majority of these patients will not have typical GERD symptoms like heartburn, and endoscopic oesophagitis, mostly grade 1, is present in only a subset of patients with LPR. Oesophageal pH monitoring is the most appropriate test to demonstrate pathological oesophageal acid exposure.