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Hypopharyngeal multichannel intraluminal impedance leads to the promising outcome of antireflux surgery in Japanese population with laryngopharyngeal reflux symptoms

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Abstract

Background

Clinical characteristics of laryngopharyngeal reflux (LPR) in Japanese population remain unclear, and its treatment outcome is suboptimal. The objectives of this study were to evaluate Japanese patients with LPR symptoms using hypopharyngeal multichannel intraluminal impedance (HMII) and to assess the outcome of antireflux surgery (ARS).

Methods

Subjects included patients who had LPR symptoms for > 12 weeks or laryngoscopic findings suggestive of LPR and underwent laryngoscopy and esophageal testing including HMII. Abnormal proximal exposure (APE) was defined as LPR ≥ 1/day and/or full column reflux (FCR) (reflux 2 cm distal to the upper esophageal sphincter) ≥ 5/day on HMII. Patients with APE were offered ARS and the outcome of ARS was objectively assessed using Reflux Symptom Index (RSI).

Results

From July 2015 to September 2016, 52 patients with LPR symptoms (28 men, 24 women, median BMI 22.3) underwent HMII, and 38 patients (73%) had APE. Of them, 29 (76%) patients were not obese (BMI < 25) and 19 (50%) patients had a negative DeMeester score. Approximately one-third of LPR and FCR events were non-acid in the distal esophagus. A positive symptom-association probability was seen only in 18 patients (35%). Mild esophagitis and hiatal hernia were found in 5 (10%) and 23 (48%) patients, respectively. All 12 patients (100%) who had undergone ARS were able to discontinue PPI and had a significant improvement in the RSI scores postoperatively (22.9 ± 10.0 vs. 6.8 ± 6.8, p < .001).

Conclusions

APE was frequently observed in Japanese patients with LPR symptoms. Obesity and esophagitis were uncommon in this population. Since a large number of patients with APE had negative DeMeester score and proximal reflux events were often non-acid, a conventional pH monitoring is insufficient. HMII is crucial to evaluate patients with LPR symptoms as the documentation of APE is a key for successful outcome of ARS.

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Abbreviations

LPR:

Laryngopharyngeal reflux

GERD:

Gastroesophageal reflux disease

PPI:

Proton pump inhibitor

MII:

Multichannel intraluminal impedance

HMII:

Hypopharyngeal MII

APE:

Abnormal proximal exposure

FCR:

Full column reflux

UES:

Upper esophageal sphincter

ARS:

Antireflux surgery

BMI:

Body mass index

RSI:

Reflux symptom index

FSSG:

Frequency scale for the symptoms of GERD

RFS:

Reflux finding score

LA:

Los Angeles

HRM:

High-resolution manometry

EGJ:

Esophagogastric junction

IEM:

Ineffective esophageal motility

LES:

Lower esophageal sphincter

SAP:

Symptom-association probability

NERD:

Non-erosive gastroesophageal reflux disease

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Acknowledgements

We thank Tadanao Takeno, Urara Funakoshi for her technical assistance.

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Authors and Affiliations

  1. Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, Japan

    Takeshi Suzuki & Yoshitaka Okamoto

  2. Minimally Invasive Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, Japan

    Yosuke Seki

  3. Esophageal & Lung Institute, Allegheny Health Network, 4815 Liberty Avenue, Mellon Pavilion, Suite 158, Pittsburgh, PA, 15224, USA

    Toshitaka Hoppo

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  1. Takeshi Suzuki
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Correspondence to Toshitaka Hoppo.

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Drs. Takeshi Suzuki, Yosuke Seki, Yoshitaka Okamoto, and Toshitaka Hoppo have no conflicts of interest or financial tie to disclose.

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Suzuki, T., Seki, Y., Okamoto, Y. et al. Hypopharyngeal multichannel intraluminal impedance leads to the promising outcome of antireflux surgery in Japanese population with laryngopharyngeal reflux symptoms. Surg Endosc 32, 2409–2419 (2018). https://doi.org/10.1007/s00464-017-5940-z

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