BackgroundPulmonary manifestation of gastro-oesophageal reflux disease (GORD) is a well-recognised entity, however little primary reported data exists on presenting symptoms of patients in whom reflux micro-aspiration is confirmed. The aim of this study is to report symptoms and presenting patterns of a large group of patients with confirmed reflux micro-aspiration.Patients and methodsData was extracted from a prospectively populated database of patients referred to a tertiary specialist centre with severe, refractory, or atypical reflux. Patients with reflux micro-aspiration on scintigraphy were included in this study. Separate group included patients with evidence of proximal reflux to the level of pharynx when supine and/or upright.ResultsInclusion criteria were met by 243 patients with confirmed reflux micro-aspiration (33% males; mean age 59). Most common symptoms amongst patients with micro-aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Cluster analysis demonstrated two main symptom groupings, one suggestive of proximal volume reflux symptoms and the other with motility/inflammatory bowel syndrome (IBS)-like symptoms (bloat, constipation).ConclusionCombination of typical symptoms of GORD such as heartburn or regurgitation and a respiratory or upper aero-digestive complaint such as cough, throat clearing, or voice change should prompt consideration of reflux micro-aspiration.
Laryngopharyngeal reflux (LPR) refers to the reflux of gastric contents into the larynx, pharynx and lungs, causing extra-oesophageal symptoms and complications such as hoarseness, chronic cough and voice disorders (Koufman, 1991). LPR is distinct from typical gastrooesophageal reflux disease (GORD), which manifests with typical symptoms such as heartburn, and yet a common pathophysiology of gastric reflux broadly unifies the two diagnoses as reflux phenomena in the Montreal classification (Vakil et al., 2006).
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