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A new diagnostic paradigm for laryngopharyngeal reflux disease: correlation of impedance-pH monitoring and digital reflux scintigraphy results

  • Laryngology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

No gold-standard investigation exists for laryngopharyngeal reflux (LPR). Multichannel intraluminal impedance (MII)-pH testing has uncertain utility in LPR. Meanwhile, reflux scintigraphy allows immediate and delayed visualisation of tracer reflux in the esophagus, pharynx, and lungs. The present study aimed to correlate MII-pH and scintigraphic reflux results in patients with primary LPR.

Methods

Consecutive patients with LPR underwent MII-pH and scintigraphic reflux studies. Abnormal values for MII-pH results were defined from existing literature. MII-pH and scintigraphic data were correlated.

Results

105 patients with LPR [31 males (29.5%), median age 60 years (range 20–87)] were studied. Immediate scintigraphic reflux was seen in the pharynx in 94 (90.4%), and in the proximal esophagus in 94 (90.4%). Delayed scintigraphic contamination of the pharynx was seen in 101 patients (96.2%) and in the lungs of 56 patients (53.3%). For MII-pH, abnormally frequent reflux was seen in the distal esophagus in 12.4%, proximal esophagus in 25.7%, and in the pharynx in 82.9%. Patients with poor scintigraphic clearance had higher Demeester scores (p = 0.043), more proximal reflux episodes (p = 0.046), more distal acid reflux episodes (p = 0.023), and more prolonged bolus clearance times (p = 0.002).

Conclusion

Reflux scintigraphy has a high yield in LPR patients. Scintigraphic time-activity curves correlated with validated MII-pH results. A high rate of pulmonary microaspiration was found in LPR patients. This study demonstrated a high level of pharyngeal contamination by scintigraphy and MII-pH, which supports the use of digital reflux scintigraphy in diagnosing LPR.

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Authors and Affiliations

  1. Department of Surgery, Concord Repatriation General Hospital, Sydney, NSW, Australia

    Jin-soo Park, Oleksandr Khoma & Gregory Leighton Falk

  2. School of Medicine, University of Notre Dame, Sydney, NSW, Australia

    Jin-soo Park, Oleksandr Khoma, Leticia Burton & Hans Van der Wall

  3. CNI Meadowbank, Sydney, NSW, Australia

    Leticia Burton & Hans Van der Wall

  4. University of Sydney, Sydney, NSW, Australia

    Gregory Leighton Falk

Authors
  1. Jin-soo Park
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  2. Oleksandr Khoma
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  3. Leticia Burton
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  4. Hans Van der Wall
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  5. Gregory Leighton Falk
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All authors made substantial contributions to this study, approved the version to be published, and agree to be accountable for all aspects of the work.

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Correspondence to Jin-soo Park.

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Ethics approval as per Sydney Local Health District (Concord Hospital) Human Research Ethics Committee, reference LNR/12/CRGH/248.

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Park, Js., Khoma, O., Burton, L. et al. A new diagnostic paradigm for laryngopharyngeal reflux disease: correlation of impedance-pH monitoring and digital reflux scintigraphy results. Eur Arch Otorhinolaryngol 278, 1917–1926 (2021). https://doi.org/10.1007/s00405-021-06658-z

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  • DOI: https://doi.org/10.1007/s00405-021-06658-z

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