Introduction
Laryngopharyngeal reflux (LPR) is an inflammatory condition of the upper
aerodigestive tract tissue related to direct and indirect effects of
gastroduodenal content reflux, inducing morphological changes in the
upper aerodigestive tract.1 LPR is evaluated based on
laryngeal symptoms and findings. Empirical proton pump inhibitors (PPIs)
along with lifestyle modifications are mainly used to treat patients
with suspected LPR.1,2 However, some patients with
suspected LPR do not experience remission of LPR symptoms despite
long-term high-dose PPI therapy. This is because of various causes, such
as patient compliance, lifestyle, and overdiagnosis of
LPR.3
The 24-h multichannel intraluminal impedance (MII)-pH monitoring is most
reliable to precisely detect the characteristics of reflux (acid vs.
nonacid; gas vs. liquid) and diagnose LPR. Recent studies found that
patients with suspected LPR refractory to PPI therapy did not exhibit
abnormal findings in MII-pH monitoring.4,5 However,
some patients with LPR with proximal all reflux episodes ≥1 in 24-h
MII-pH monitoring are refractory to PPI therapy.6 It
is unclear which patients with LPR might benefit from the PPI therapy.
To the best of our knowledge, the association between response to PPI
therapy and parameters of 24-h MII-pH monitoring in patients with LPR
has not been studied.
This study aimed to (i) evaluate reflux characteristics in patients with
LPR refractory to PPI therapy using 24-h MII-pH monitoring and (ii)
identify parameters and associated values to predict the response to PPI
therapy in such patients.