Low pillow height is associated with LPR among patients with GERD: a retrospective single-center study

Gastroesophageal reflux disease (GERD) combined with laryngo-pharyngeal reflux (LPR) has poor drug efficacy, which seriously affects their mental health and quality of life. Investigation of the risk factors and construct predictive models to improve preventive strategies. A total of 323 GERD patients (192 with simple GERD, 131 with LPR) and 225 healthy controls were enrolled in Yijishan Hospital of Wannan Medical College. All participants underwent sedated upper endoscopy with laryngeal examination. They were evaluated using the GerdQ, RSI, and RFS instruments, and relevant risk factors were analyzed via questionnaire. Sedated upper endoscopy demonstrated value in detecting laryngeal reflux. Significant differences existed between healthy controls and GERD patients for age, waist circumference, high-fat diet, eating too fast, overeating, supine after meals, anxiety, and depression (all p ≤ 0.05). GERD + LPR patients differed significantly from GERD-only patients in high-fat diet, eating too fast, overeating, supine position after meals (≤ 30 min), low pillow height, cervical spondylosis, and anxiety (p ≤ 0.05). Multivariable analysis identified six independent correlates ranked by effect size: low pillow height (largest) > supine position after meals > anxiety > eating too fast > overeating > high-fat diet. The 6-factor nomogram model achieved an Area Under Curve (AUC) of 0.775 (95% CI: 0.723 ~ 0.826), with bootstrap-validated AUC of 0.772 (95% CI: 0.768 ~ 0.776). Calibration was satisfactory, and Decision Curve (DCA) indicated clinical utility across a wide probability range. Low pillow height was the strongest correlate of GERD + LPR in this cohort, and sedated upper endoscopy can effectively observe laryngopharyngeal inflammation and assist the diagnosis of LPR. This model provides an internally validated exploratory tool for clinical identification of high-risk patients, aiding early identification and personalized prevention.