Abstract
Objectives: This study evaluated the characteristics of reflux
in patients with laryngopharyngeal reflux (LPR) refractory to proton
pump inhibitor (PPI) therapy using the 24-h multichannel intraluminal
impedance (MII)-pH monitoring.
Design: Prospective cohort study.
Setting: A tertiary care otolaryngology clinic.
Participants: Patients with suspected LPR underwent 24-hour
MII-pH monitoring and were prescribed high-dose PPI twice daily.
One-hundred and eight patients followed up for at least 2 months were
enrolled.
Main outcome measures: Patients with suspected LPR showing more
than one proximal reflux episode were considered to have LPR. Patients
with LPR showing ≥50% decrease in the follow-up reflux symptom index
(RSI) score compared to the pre-treatment RSI score during treatment
periods were defined as responders; others were defined as
non-responders. Various parameters in the 24-h MII-pH monitoring between
non-responders and responders with LPR were compared using Student’st -test.
Results: Of 108 patients with suspected LPR, 80 were diagnosed
with LPR. Patients with LPR were categorized as non-responders (n = 19)
and responders (n = 61). Proximal all reflux time and proximal longest
reflux time in MII parameters were significantly higher in responders
than in non-responders (p = 0.0040 and 0.0216, respectively). The
proximal all reflux time >0.000517% was a better cut-off
value to predict responders with LPR compared to the proximal longest
reflux time >0.61 min (sensitivity + specificity: 1.317 vs.
1.291).
Conclusions: The proximal all reflux time can be helpful to
predict the response to PPI therapy and establish a personalized
therapeutic scheme in patients with LPR.
Keywords: laryngopharyngeal reflux, multichannel intraluminal
impedance (MII)-pH, proton pump inhibitor, refractory, proximal all
reflux time