Clinical and psychological characteristics in gastroesophageal reflux disease patients overlapping with laryngopharyngeal reflux symptoms

Abstract

Background and Aim Laryngopharyngeal reflux (LPR) defined as reflux of gastric content reaching above the upper esophageal sphincter is frequently found in patients with gastroesophageal reflux disease (GERD). This study aimed to investigate clinical and psychological differences between GERD patients with or without LPR symptoms. Methods This study enrolled 303 consecutive patients with proton pump inhibitor treatment‐naïve scheduled for upper endoscopy because of troublesome reflux symptoms and recognized as GERD by non‐dyspepsia reflux disease questionnaire score. Included GERD patients were further categorized into two study groups: with or without LPR by reflux symptoms index score. All participants were also evaluated with questionnaires for depression, anxiety, and sleep disturbances. Results There were 132 (43.6%) GERD patients with LPR symptoms and 171 (56.4%) GERD patients without LPR symptoms. GERD patients with LPR symptoms had more depression (P < 0.001), sleep disturbance (P = 0.002), irritable bowel syndrome (P = 0.008), functional dyspepsia (P = 0.005), and reflux symptoms burden (P < 0.001) than those without LPR symptoms. Erosive esophagitis was more in patients without LPR symptoms (P = 0.03). GERD patients with LPR symptoms (28.8%) had more complex psychological distress than those without LPR symptoms (28.8% vs 14%, P < 0.001). Reflux symptoms burden, sleep disturbance, and erosive esophagitis were independently associated with GERD overlapping with LPR symptoms. Conclusions Gastroesophageal reflux disease patients with LPR symptoms appear to have more reflux symptoms, psychological distress, and functional gastrointestinal disturbance but less erosive esophagitis. This work suggests that therapeutic strategy with tailored multidimensional approach is promising for GERD patients overlapping with LPR symptoms.

<p>Pump Proton and Laryngeal H⁺/K⁺ ATPases</p>

“…Laryngopharyngeal reflux disease (LPRD) comprises a group of symptoms and signs caused by reflux of the gastric contents into the upper esophageal sphincter and is therefore considered an extra-esophageal variant of gastroesophageal reflux disease (GERD). 1,2 However, whether the true pathogenesis of LPRD involves reflux of the gastric contents is unclear. The different symptoms of GERD and LPRD suggest that they are, at least clinically, two different diseases.…”

“…Nonetheless, the proton pump is central to both LPRD and GERD. [1][2][3]7,8 Whereas the gastric H + /K + ATPase is a well-characterized proton pump mediating gastric acid secretion, [7][8][9] other H + /K + ATPases may be present in organs outside the stomach, such as the larynx. The presence of extra-gastric H + /K + ATPases may explain the clinically significant effect of proton pump inhibitor (PPI) pharmacotherapy in patients with chronic laryngitis related to LPRD but without GERD symptoms.…”

Psychiatric Symptoms and the Upper Esophageal Sphincter

“…In the hypotonic UES group, the median of HADS score were for HADS-T 13 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), HADS-A 7(5-10) and HADS-D 6(3-8). In the normotonic UES group: for HADS-T 13(9-19), HADS-A 8(5-11) and HADS-D 6(3.75-8).…”

Association between gastroesophageal reflux disease and depression disorder

“…[ 16 ] To date, a few studies describing GERD have shown that psychological factors, particularly anxiety and depression, play an important role in patients with GERD. [ 17 – 19 ] However, a comprehensive explication of this association had not yet been given. Thus, this study aims to systematically investigate the association between GERD and DD.…”