The correlation between esophageal pressure topographic metrics and symptom severity in patients with laryngopharyngeal reflux disease refractory to proton pump inhibitors

Objectives Laryngopharyngeal reflux disease (LPRD) cases are usually diagnosed based on a reflux index score of over 13 and are then treated by a 12-week intervention with proton pump inhibitors (PPIs). However, many such patients also have associated primary motility disorders when subjected to high-resolution esophageal manometry, and therefore analysis of the latter may reveal correlations of its metrics, if any, with the symptom severity after proton-pump therapy. Material and Methods Patients with LPRD (41) having a reflux index score of 13 and above were treated with a 12-week regimen of PPIs. Of them, 23 did not show significant improvement in their scores, while the remaining 18 did. Both these groups of patients were then subjected to high-resolution esophageal manometry. Various esophageal pressure topographic metrics were recorded and analyzed for participants from both groups. Results The most common manometry finding among participants from both groups was an esophageal motility pattern with all topographic metrics falling within the normal limits. Patients with high reflux symptom scores but normal esophageal motility had normal esophageal topographic metrics regardless of their response to PPIs. However, median basal lower esophageal sphincter pressure, median integrated relaxation pressure, and median distal contractile integral were found to be very strongly correlated to the symptom severity scores among the patients who responded to therapy. Conclusion Symptom severity scores provide a general guideline for clinicians to initiate a 12-week regimen of PPIs to which many of the patients of LRPD eventually respond. In addition, high-resolution manometry identifies those cases having an associated primary motility disorder but does not provide information on whether the high symptom severity scores are because of these disorders, reflux or a combination of both. While esophageal pressure topographic metrics by far do not single out laryngopharyngeal disease from a group of patients with mixed disorders, a few of these metrics do have a strong correlation with the changes in the symptom severity scores following a 12-week intervention with PPIs. Thus, high-resolution manometry should be performed in such patients as an adjunct for a more robust diagnostic armamentarium.