709 PL11.05 NOVEL DIGITAL REFLUX SCINTIGRAPHY DETECTS PULMONARY MICROASPIRATION IN SEVERE GASTRO-OESOPHAGEAL AND LARYNGOPHARYNGEAL REFLUX DISEASE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jin-soo Park ◽  
Leticia Burton ◽  
Hans Van der Wall ◽  
Gregory Falk
Keyword(s):  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Severe Disease ◽  
Symptomatic Treatment ◽  
Pulmonary Aspiration ◽  
High Rate ◽  
Digital Technique ◽  
Predominant Symptom ◽  
Symptom Profile ◽  
Predominantly Female

Abstract   No gold-standard diagnostic test for laryngopharyngeal reflux (LPR) exists. Symptoms alone are non-diagnostic, and pH-impedance studies have poor sensitivity. Pulmonary micro-aspiration is under-recognised in LPR and gastro-oesophageal reflux disease (GORD). The present study aimed to describe the results of a novel digital technique for scintigraphic reflux studies in two groups with severe reflux: those with typical reflux symptoms and those with laryngopharyngeal manifestations of reflux. Methods A prospective database of severely symptomatic, treatment-resistant reflux patients was grouped based upon predominant symptom profile of typical GORD or LPR. All patients underwent novel reflux scintigraphy. Results were obtained for early scintigraphic reflux contamination of the pharynx and proximal oesophagus, and delayed contamination of the pharynx and lungs after two hours. Results The LPR patients were predominantly female (70.5% vs. 56.1%; p = 0.042) and older than the GORD group (median age 60 years vs. 55.5 years; p = 0.002). Early scintigraphic reflux was seen at the pharynx in 89.2% (GORD 87.7%, LPR 90.4%; p = 0.133), and at the proximal oesophagus in 89.7% (GORD 88.9%, LPR 90.4%; p = 0.147). Delayed contamination of the pharynx was seen in 95.2% (GORD 93.9%, LPR 96.2%; p = 0.468). Delayed pulmonary aspiration was seen in 46% (GORD 36.6%, LPR 53.3%; p = 0.023). Conclusion Reflux scintigraphy demonstrated a high rate of digitally identified reflux pulmonary aspiration. Contamination of the proximal oesophagus and pharynx was observed frequently in both groups of severe disease. The likelihood of pulmonary aspiration and potential pulmonary disease needs to be entertained in severe GORD and LPR.

PS01.011: PATHOPHYSIOLOGY OF LARYNGOPHARYNGEAL REFLUX DISEASE: ASSOCIATION WITH PULMONARY ASPIRATION ON SCINTIGRAPHY AND INEFFECTIVE OESOPHAGEAL MOTILITY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 52-53
Author(s):  
Oleksandr Khoma ◽  
Michael Falk ◽  
Hans Van Der Wall ◽  
Leticia Burton ◽  
Gregory Falk
Keyword(s):  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Pulmonary Aspiration ◽  
Research Database ◽  
Oesophageal Motility ◽  
Upper Airways ◽  
Time Activity ◽  
Predictive Values ◽  
Symptom Profile ◽  
Oesophageal Dysmotility

Abstract Background Gastro-oesophageal reflux disease (GORD) can present with typical symptoms or atypical or laryngopharyngeal reflux (LPR) symptoms. The role of impaired oesophageal motility in these two clinically distinct groups has not been previously examined. Methods This study is a retrospective analysis of 361 consecutive patient records that was extracted from a prospectively populated research database. Patients were categorised by symptom profile as predominantly LPR or GORD (98 GOR and 263 LPR). Presenting symptom profile, pH studies, oesophageal manometry and scintigraphy and the relationship between the above were analysed. Results Severe oesophageal dysmotility was more prevalent in LPR group (P = 0.037). Severe oesophageal dysmotility was strongly associated with isotope aspiration in both groups (P = 0.001). 24 per cent of patients showed evidence of pulmonary aspiration on scintigraphy. Significant correlation was established between total proximal acid on 24-hour pH monitoring and isotope aspiration in both groups (P = 0.00). Rising pharyngeal curves on scintigraphy were the strongest predictors of isotope aspiration (P = 0.00). Conclusion Early research on oesophageal dysmotility has suggested reduced oesophageal clearance in individuals with IOM. This selected group of patients showed a high degree of impaired oesophageal motility, which was associated with rising time-activity curves in both the upper oesophagus and pharynx. The presence of refluxate in the upper oesophagus can stimulate cough via ‘reflex’ afferent pathways and the presence of gastric contents in the pharynx can cause direct irritation to upper airways, both resulting in cough. Reduced pressures in the lower oesophageal sphincter were equally prevalent in LPR and GORD groups and therefore were not discriminatory between the clinical groups. The impairment of oesophageal clearance secondary to diminished oesophageal motility, may offer a plausible explanation for the development of symptoms via combined ‘reflux’ and ‘reflex’ pathways, allowing continued oesophageal exposure or proximal exposure to refluxate. The ROC and cluster analysis demonstrated strong predictive values and linkages between ineffective oesophageal motility and rising pharyngeal time-activity curves for the prediction of lung aspiration. This may form the basis of a new approach to the definitive diagnosis of LPR and lung aspiration. Oesophageal dysmotility is a key factor in pathophysiology of LPR. Severe impaired oesophageal motility is strongly associated with pulmonary aspiration in both LPR and GORD. Disclosure All authors have declared no conflicts of interest.

711 POST-REFLUX SWALLOW-INDUCED PERISTALTIC WAVE IS IMPAIRED IN LARYNGOPHARYNGEAL AND GASTRO-OESOPHAGEAL REFLUX DISEASE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jin-soo Park ◽  
Hans Van der Wall ◽  
Gregory Falk
Keyword(s):  
Roc Curve ◽  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Reflux Episode ◽  
Oesophageal Reflux ◽  
Peristaltic Wave ◽  
Oesophageal Reflux Disease ◽  
Predominant Symptom ◽  
Symptom Profile ◽  
Gastric Contents

Abstract   Laryngopharyngeal reflux (LPR) and gastro-oesophageal reflux disease (GORD) result from the reflux of gastric contents. The post-reflux swallow-induced peristaltic wave (PSPW) induces chemical clearance following reflux events. PSPW index is a novel parameter that has been validated in GORD, but not in LPR. This study aimed to assess the efficacy of chemical clearance by assessing PSPW indices in patients with LPR and GORD. Methods Reviewers blindly analysed off-therapy impedance-pH tracings from 187 patients divided into LPR (n = 105) or GORD (n = 82) by predominant symptom profile. Conventional impedance-pH measures and PSPW indices were analysed for the two groups. Results Mean PSPW index in the LPR group was higher than in the GORD group (39.7% (±17.7%) vs. 20.6% (±13.4%); p < 0.001). Abnormally low PSPW index (<61%) was seen in 85 (81%) of the LPR group, and 80 (97.6%) of the GORD group (p < 0.001). Area under the ROC curve for PSPW index to diagnose LPR was 0.828 (95% CI: 0.767–0.889; p < 0.001). The LPR group had a lower AET (1.5% vs. 8.1%; p < 0.001) and fewer distal reflux episodes (46.5 (±24.5) vs. 64.4 (±39); p < 0.001). Conclusion PSPW was impaired in patients with LPR as well as oesophageal GORD, indicating an abnormality of chemical clearance following a reflux episode in both groups. PSPW index was more severely impaired in gastro-oesophageal reflux disease (GORD). The present study shows PSPW index is useful in aiding in the diagnosis of both LPR and GORD.

720 CONVENTIONAL AND SIMPLE METHODS OF MEASURING MEAN NOCTURNAL BASELINE IMPEDANCE SHOW EXCELLENT AGREEMENT

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jin-soo Park ◽  
Hans Van der Wall ◽  
Gregory Falk
Keyword(s):  
Excellent Agreement ◽  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Measurement Methods ◽  
Distal Esophagus ◽  
Simple Method ◽  
Proximal Esophagus ◽  
Predominant Symptom ◽  
Symptom Profile

Abstract   Mean nocturnal baseline impedance (MNBI) is a measurement that shows promise in investigating reflux disease by reflecting esophageal mucosal integrity. The conventional method of measuring MNBI is time-consuming and operator-dependent. A new, simple method of measuring MNBI has been suggested. This study aimed to report MNBI measurements by both conventional and simple methods in a cohort of laryngopharyngeal reflux (LPR) and gastro-esophageal reflux disease (GERD) patients to validate the simple measurement method. Methods 187 patients were divided into LPR (n = 105) or GERD (n = 82) groups by predominant symptom profile, and underwent off-therapy impedance-pH monitoring. MNBI was blindly measured by both conventional and simple methods, and values were correlated. Bland–Altman plots were constructed to assess mean differences and to identify bias between the two measurement methods. Results For the two measurement methods, mean difference in the distal esophagus was −89 (±328) ohms, in the proximal esophagus was −6 (±653) ohms, and in the pharynx was 128 (±577) ohms. There was strong correlation between conventional and simple MNBI values, with r = 0.940 in the distal esophagus, r = 0.463 in the proximal esophagus, and r = 0.712 in the pharynx (all p < 0.001). Conclusion There was excellent agreement between conventional and simple methods of measuring MNBI, with no evidence of proportional bias. Conventional and simple MNBI values correlated excellently in the distal esophagus, and moderately well in the proximal esophagus and pharynx. This study supports the use of the simple method of measuring MNBI to enhance diagnosis of reflux disease.

Optimal Regimen and Period for the Treatment of Patients with Laryngopharyngeal Reflux Disease

2014 ◽  
Vol 57 (10) ◽  
pp. 698 ◽  
Author(s):  
Yun Jae Lee ◽  
Min Kyu Kwak ◽  
Ji Hun Eom ◽  
Yong Bae Ji ◽  
Chang Myeon Song ◽  
...  
Keyword(s):  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Laryngopharyngeal Reflux Disease ◽  
Optimal Regimen

Influence of Helicobacter pylori Infection on Laryngopharyngeal Reflux Disease

2006 ◽  
Vol 57 (3) ◽  
pp. 268-272
Author(s):  
Ray Motohashi ◽  
Yusuke Watanabe ◽  
Ryoji Tokashiki ◽  
Kazuhiro Nakamura ◽  
Mamoru Suzuki
Keyword(s):  
Helicobacter Pylori ◽  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Helicobacter Pylori Infection ◽  
Laryngopharyngeal Reflux Disease

Modified Reflux Scintigraphy Detects Pulmonary Microaspiration in Severe Gastro-Esophageal and Laryngopharyngeal Reflux Disease

Lung ◽  
2021 ◽  
Vol 199 (2) ◽  
pp. 139-145
Author(s):  
Jin-soo Park ◽  
Leticia Burton ◽  
Hans Van der Wall ◽  
Gregory Leighton Falk
Keyword(s):  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Laryngopharyngeal Reflux Disease

scholarly journals Allergic rhinitis, asthma and laryngopharyngeal reflux disease: a cross-sectional study on their reciprocal relations

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ameer Kakaje ◽  
Mohammad Marwan Alhalabi ◽  
Ayham Alyousbashi ◽  
Ayham Ghareeb
Keyword(s):  
Allergic Rhinitis ◽  
Reflux Disease ◽  
Medical Condition ◽  
Laryngopharyngeal Reflux ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Cross Sectional ◽  
Wide Range

AbstractAllergic rhinitis (AR) is a common medical condition worldwide. It is an inflammation in the nasal mucosa due to allergen exposure throughout the year. Laryngopharyngeal reflux (LPR) is another medical condition that can overlap with AR. LPR can be considered an extra oesophageal manifestation of gastro-oesophageal reflux disease (GORD) or a different entity. Its diagnosis imposes a real challenge as it has a wide range of unspecific symptoms. Although AR and LPR are not life-threatening, they can severely affect the quality of life for years and cause substantial distress. Moreover, having AR is associated with having asthma which is also in turn associated with GORD. This is a cross-sectional study which used surveys distributed online on Social Media and targeted people across Syria. All participants who responded to the key questions were included. Reflux symptom index (RSI) was used for LPR, and score for allergic rhinitis (SFAR) was used for AR. Demographic questions and whether the participant had asthma were also included in the survey. We found that there was an association between the symptoms of LPR and AR p < 0.0001 (OR, 2.592; 95% CI 1.846–3.639), and their scores were significantly correlated (r = 0.334). Having asthma was associated with LPR symptoms p = 0.0002 (OR 3.096; 95% CI 1.665–5.759) and AR p < 0.0001 (OR 6.772; 95% CI 2.823–16.248). We concluded that there was a significant association between having LPR, AR, and asthma. We need more studies to distinguish between their common symptoms and aetiologies.

708 A NEW DIAGNOSTIC PARADIGM FOR LARYNGOPHARYNGEAL REFLUX DISEASE: CORRELATION OF IMPEDANCE-PH MONITORING AND DIGITAL REFLUX SCINTIGRAPHY RESULTS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jin-soo Park ◽  
Oleksandr Khoma ◽  
Hans Van Der Wall ◽  
Gregory Falk
Keyword(s):  
Laryngopharyngeal Reflux ◽  
Ph Monitoring ◽  
Acid Reflux ◽  
High Rate ◽  
High Yield ◽  
Time Activity ◽  
Proximal Esophagus ◽  
Laryngopharyngeal Reflux Disease ◽  
High Level ◽  
No Gold Standard

Abstract   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. 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%). Abnormal 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 longer 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.

A Randomized Clinical Trial of Proton Pump Inhibitors Combined with Traditional Chinese Medicine in the Treatment of Laryngopharyngeal Reflux Disease

2021 ◽  
Author(s):  
Feng Pei ◽  
Wei Jia Hu ◽  
Yi Nan Mao ◽  
Yu Liang Zhao
Keyword(s):  
Proton Pump ◽  
Reflux Disease ◽  
Laryngopharyngeal Reflux ◽  
Short Form ◽  
Therapeutic Effects ◽  
Reflux Symptom Index ◽  
Symptom Index ◽  
Laryngopharyngeal Reflux Disease ◽  
Group A ◽  
Group B

Background:To explore whether combined with TCM based on classical proton pumpinhibitors PPIs therapy can achieve better efficacy for patients withlaryngopharyngeal reflux disease. Methods: There were 150 laryngopharyngeal refluxpatients enrolled and divided into three groups randomly, with 50 cases in each group.Patients in group A were treated with the proton pump inhibitor (PPI) lansoprazole.Patients in group B were treated with lansoprazole combined with Banxia Houpudecoction, and patients in group C were treated with acupuncture treatments and acombination of Chinese and Western medicine. The reflux symptom index (RSI), refluxfinding score (RFS), and quality of life (36 item short form health survey questionnaire)were assessed before and 4 and 8 weeks after treatment. Results: The RSI and RFSscores of the three groups were significantly reduced after treatment (P < 0.001). Ingroup B and C, they were lower than in group A at 8 weeks (P < 0.01). The SF 36 scoreof 3 groups increased after treatment. At both 4 and 8 weeks (P < 0.001), and patientsin groups B and C scored higher than patients in group A (P < 0.001). The total effectiverate of group B and group C was higher than that of group A (P < 0.05). Conclusion:All three treatments have therapeutic effects on the disease, but the efficacy of a PPIalone is not as good as the combined treatments’ efficacies. Moreover, PPI combinedwith Banxia Houpu decoction and/or acupuncture treatment substantially affects lifeimprovement.

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