ISOLATED LARYNGOPHARYNGEAL SYMPTOMS DO NOT PREDICT OBJECTIVE REFLUX EVIDENCE: AN INTERNATIONAL MULTICENTER VALIDATION STUDY OF THE SAN DIEGO CONSENSUS PATHWAY FOR SELECTIVE UPFRONT TESTING

BACKGROUND: Laryngopharyngeal symptoms (LPS) refer to upper aerodigestive tract symptoms with etiologic potential for reflux pathophysiology. We aimed to characterize the clinical presentation/evaluation of LPS and identify predictors of laryngopharyngeal reflux disease (LPRD) in an international cohort of patients with LPS. METHODS: We included adult patients with LPS presenting for esophageal testing at 5 international tertiary centers in 3 world regions. Demographics, clinical symptoms, validated patient-reported outcome instruments and esophageal testing data were obtained. The diagnostic yield of objective gastroesophageal reflux disease (GERD) evidence was compared across LPS presentations. Univariate and multivariable analyses were performed, reported as odds ratios (OR) and 95% confidence intervals (CI). RESULTS: Of 408 patients (age 53.3±0.7 years, 70% female), 135 (33.1%) had isolated LPS and 273 (66.9%) had LPS with typical reflux symptoms. Symptom burden was higher in LPS with typical symptoms (p≤0.004), as was objective GERD evidence (29.7% vs 17.0%, p=0.006), with similar diagnostic yields between wireless and pH-impedance monitoring in both isolated LPS and LPS with typical symptoms (p=0.36). On multivariable logistic regression evaluating predictors for conclusive GERD, typical symptoms (OR 2.71, CI 1.33-5.55, p=0.006), hiatus hernia (OR 1.80, CI 1.24-2.62, p=0.002) and body mass index (OR 1.08, CI 1.03-1.14, p=0.002) and were independent predictors for conclusive GERD, but LPS type and severity did not predict LPRD. Across world regions, symptom burden was higher despite lower GERD evidence in Asian patients. CONCLUSIONS: Clinical presentation of isolated LPS is not predictive of LPRD, unlike LPS with typical symptoms. Our findings support the San Diego Consensus recommendations for selective up-front testing in isolated LPS.