Predictors of reflux aspiration and laryngo-pharyngeal reflux

Abstract

Background

Gastro-esophageal reflux disease (GERD) can present with typical or atypical or laryngo-pharyngeal reflux (LPR) symptoms. Pulmonary aspiration of gastric refluxate is one of the most serious variants of reflux disease as its complications are difficult to diagnose and treat. The aim of this study was to establish predictors of pulmonary aspiration and LPR symptoms.

Methods

Records of 361 consecutive patient from a prospectively populated database were analyzed. Patients were categorized by symptom profile as predominantly LPR or GERD (98 GER and 263 LPR). Presenting symptom profile, pH studies, esophageal manometry and scintigraphy and the relationships were analyzed.

Results

Severe esophageal dysmotility was significantly more common in the LPR group (p = 0.037). Severe esophageal dysmotility was strongly associated with isotope aspiration in all patients (p = 0.001). Pulmonary aspiration on scintigraphy was present in 24% of patients. Significant correlation was established between total proximal acid on 24-h pH monitoring and isotope aspiration in both groups (p < 0.01). Rising pharyngeal curves on scintigraphy were the strongest predictors of isotope aspiration (p < 0.01).

Conclusions

Severe esophageal dysmotility correlates with LPR symptoms and reflux aspiration in LPR and GERD. Abnormal proximal acid score on 24-h pH monitoring associated with pulmonary aspiration in reflux patients. Pharyngeal contamination on scintigraphy was the strongest predictor of pulmonary aspiration.

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Funding

No funding was received towards this research. Research database is approved by the University of Notre Dame Australia Human Research Ethics Committee (019091S) on 23rd of July 2019.

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Correspondence to Oleksandr Khoma.

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Khoma, O., Burton, L., Falk, M.G. et al. Predictors of reflux aspiration and laryngo-pharyngeal reflux. Esophagus 17, 355–362 (2020). https://doi.org/10.1007/s10388-020-00726-9

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Keywords

  • LPR
  • GERD
  • Reflux aspiration
  • Esophageal motility
  • Scintigraphy