Antireflux surgery leads to durable improvement in laryngopharyngeal reflux symptoms

Abstract

Background

Laryngopharyngeal reflux (LPR) symptoms are often present in patients with Gastroesophageal reflux disease (GERD). Whereas antireflux surgery (ARS) provides predictably excellent results in patients with typical GERD, those with atypical symptoms have variable outcomes. The goal of this study was to characterize the response of LPR symptoms to antireflux surgery.

Methods

Patients who underwent ARS between January 2009 and May 2020 were prospectively identified from a single institutional database. Patient-reported information on LPR symptoms was collected at standardized time points (preoperative and 2 weeks, 8 weeks, and 1 year postoperatively) using a validated Reflux Symptom Index (RSI) questionnaire. Patients were grouped by preoperative RSI score: ≤ 13 (normal) and > 13 (abnormal). Baseline characteristics were compared between groups using chi-square test or t-test. A mixed effects model was used to evaluate improvement in RSI scores.

Results

One hundred and seventy-six patients fulfilled inclusion criteria (mean age 57.8 years, 70% female, mean BMI 29.4). Patients with a preoperative RSI ≤ 13 (n = 61) and RSI > 13 (n = 115) were similar in age, BMI, primary reason for evaluation, DeMeester score, presence of esophagitis, and hiatal hernia (p > 0.05). The RSI > 13 group had more female patients (80 vs 52%, p = < 0.001), higher mean GERD-HRQL score, lower rates of PPI use, and normal esophageal motility. The RSI of all patients improved from a mean preoperative value of 19.2 to 7.8 (2 weeks), 6.1 (8 weeks), and 10.9 (1 year). Those with the highest preoperative scores (RSI > 30) had the best response to ARS. When analyzing individual symptoms, the most likely to improve included heartburn, hoarseness, and choking.

Conclusions

In our study population, patients with LPR symptoms achieved a rapid and durable response to antireflux surgery. Those with higher preoperative RSI scores experienced the greatest improvement. Our data suggest that antireflux surgery is a viable treatment option for this patient population.

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Acknowledgements

The authors would like to acknowledge Lily Stalter for her assistance with additional data analysis.

Funding

Effort on this study and manuscript was made possible by a George H. A. Clowes, Jr., MD, FACS, Memorial Research Career Development Award from the American College of Surgeons and a VA Career Development Award to Dr. Funk (CDA 015–060). The views represented in this article represent those of the authors and not those of the DVA or the US Government.

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Correspondence to Anne O. Lidor.

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Disclosure

Authors Hessler, Xu, Shada, Johnson, Funk, and Lidor have no conflicts of interest or financial ties to disclose. Jacob Greenberg is the site PI for clinical trials with Medtronic and BD Interventional. He does not take any salary support for either.

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Appendix

Appendix

See Table 4.

Table 4 Reflux symptom index (RSI) Questionnaire *Belafsky, et al.

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Hessler, L.K., Xu, Y., Shada, A.L. et al. Antireflux surgery leads to durable improvement in laryngopharyngeal reflux symptoms. Surg Endosc (2021). https://doi.org/10.1007/s00464-020-08279-9

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Keywords

  • Laryngopharyngeal reflux
  • Atypical GERD
  • Antireflux surgery