Prevalence and clinical significance of esophageal motility disorders in patients with laryngopharyngeal reflux symptoms

Sikavi, Daniel; Cai, Jennifer; Carroll, Thomas L.; Chan, Walter W.

doi:10.1111/jgh.15391

Cited by 12 publications

(14 citation statements)

References 38 publications

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“…Even then, I'd make it clear to patient the small amount of evidence available WC: Esophageal dysmotility may be associated with LPR symptoms (?secondary to reflux versus worsens reflux versus no causative relations). Our study of patients with LPR symptoms and HRM found that abnormal findings are common (43%), including 13.4% with EGJOO or a major peristaltic disorder [11]. Impaired esophageal motility may also correlate with worse LPR symptoms.…”

Section: Introductionmentioning

confidence: 64%

Distinct Clinical Physiologic Phenotypes of Patients with Laryngeal Symptoms Referred for Reflux Evaluation

Maan¹,

Yuying²,

Walter³

et al. 2022

Gijournal

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One third of adults experience laryngeal symptoms such as throat clearing and chronic cough and 50-80% of adults seeking care of these symptoms are told that laryngopharyngeal reflux (LPR) is the etiology. LPR results from retrograde flow of gastroduodenal contents to the larynx and pharynx; however, treatment of presumed LPR remains challenging with limited evidence-based guidance. This article summarizes the @GIJournal Twitter discussion of Yadlapati et al, “Distinct Clinical Physiologic Phenotypes of Patients with Laryngeal Symptoms Referred for Reflux Evaluation,” originally published in Clinical Gastroenterology and Hepatology. In this study of 302 patients with chronic laryngeal symptoms referred for reflux evaluation, five distinct phenotypic groups were described, and reflux was only present in two of the proposed phenotypes. LPR and GERD with hiatal hernia (group A); mild LPR/GERD (group B); no LPR/no GERD (group C); reflex cough (group D); and mixed/possible obstructive esophagogastric junction (EGJ) (group E). Phenotypic differences can inform targeted clinical trials design and improve outcomes.

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Section: Introductionmentioning

confidence: 64%

Distinct Clinical Physiologic Phenotypes of Patients with Laryngeal Symptoms Referred for Reflux Evaluation

Maan¹,

Yuying²,

Walter³

et al. 2022

Gijournal

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“…However, the prevalence of IEM per CCv3.0 in our study is lower than reported in previous literature. Sikavi et al 14 reported a prevalence of IEM of 30.0%, though this was in a population previously diagnosed with laryngopharyngeal reflux. Boland et al 2 also reported a prevalence of 31.0%, a number that had increased with the advent of HRIM.…”

Section: Discussionmentioning

confidence: 89%

Clinical Characteristics of Patients With Ineffective Esophageal Motility by Chicago Classification Version 4.0 Compared to Chicago Classification Version 3.0

Kurin

Adil

Damjanovska

et al. 2023

J Neurogastroenterol Motil

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Background/AimsChicago classification version 4.0 (CCv4.0) of esophageal motility disorders developed a more stringent diagnostic criteria for ineffective esophageal motility (IEM) than version 3.0. We studied the implications of the new diagnostic criteria on the prevalence of IEM, and clinically characterized and compared the population of patients who no longer meet diagnostic criteria for IEM to those who retain the diagnosis. MethodsWe included all consecutively performed high-resolution esophageal impedance manometries from 2014 to 2021. Three cohorts of patients with IEM were created: Patients with IEM by Chicago classification version 3.0 (CCv3.0; CC3 group), by CCv4.0 only (CC4 group), and by CCv3.0 who are now considered normal (Normal group). Demographics, manometric and reflux parameters, and clinical outcomes were compared. ResultsA total of 594 manometries were analyzed. Of those, 66 (11.1%) met criteria for IEM by CCv3.0 (CC3), 41 (62.0%) retained an IEM diagnosis using CCv4.0 criteria (CC4), while 25 (38.0%) patients no longer met criteria for IEM (Normal). The CC4 group had higher esophageal acid exposure, especially supine (% time -18.9% vs 2.2%; P = 0.005), less adequate peristaltic reserve (22.0% vs 88.0%; P = 0.003), and higher Demeester score (49.0 vs 21.2; P = 0.017) compared to the Normal group. There was no difference in bolus clearance between the groups. ConclusionsIEM under CCv4.0 has a stronger association with pathologic reflux, especially supine reflux, and inadequate peristaltic reserve, but impairment in bolus clearance is unchanged when compared with IEM diagnosed based on CCv3.0. Further studies are required to determine the implications of these findings on management strategies.

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“…Thus, Sikavi et al observed that LPR patients (with or without coexisting motility disorder) had reduced proximal esophageal contractibility at the high-resolution manometry, which significantly predicted increased of HREs [ 2 ]. The same team reported in another publication that 43.3% of patients with LPR at the HEMII-pH had abnormal findings at the high-resolution manometry, with the ineffective esophageal motility being the most common diagnosis [ 54 ]. Interestingly, recent findings reported that most HREs are weakly or nonacid [ 6 , 38 , 41 , 55 ], which supports the consideration of alginate or magaldrate in the therapeutic strategy [ 32 , 55 ].…”

Section: Diagnosis Of Reflux and Place Of Ph Studymentioning

confidence: 99%

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

Lechien

2022

JCM

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Purpose: The diagnosis of laryngopharyngeal reflux (LPR) is commonly based on non-specific symptoms and findings and a positive response to an empirical therapeutic trial. The therapeutic response is, however, unpredictable, and many patients need pH-impedance monitoring to confirm the diagnosis. Methods: A review of the recent literature was conducted in PubMED, Scopus, and Embase about the pH-study features of LPR patients. A summary of last evidence was proposed. Results: The awareness of otolaryngologists about indications and interpretation of pH-impedance monitoring is low. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH monitoring (HEMII-pH) is the most reliable examination determining the type and composition of hypopharyngeal reflux events (HRE) and the LPR features. The use of HEMII-pH is important to confirm the diagnosis in selected patients because non-specificity of symptoms and findings. There are no international consensus guidelines for the LPR diagnosis at the HEMII-pH. However, most studies supported the occurrence of >1 acid/weakly acid/nonacid HRE as diagnostic threshold. HREs are more frequently gaseous, weakly/nonacid compared with reflux events of gastroesophageal reflux. HREs occurred as daytime and upright, which does not support the value of double proton pump inhibitors or bedtime alginate. Oropharyngeal pH-monitoring is another approach reporting different sensitivity and specificity outcomes from HEMII-pH. The use of Ryan score for the LPR diagnosis at the oropharyngeal pH monitoring may be controversial regarding the low consideration of alkaline HREs. Conclusions: The awareness of otolaryngologists about HEMII-pH indication, features, and interpretation is an important issue regarding the high prevalence of LPR in outpatients consulting in otolaryngology. The HEMII-pH findings may indicate a more personalized treatment considering type and occurrence time of HREs.

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Prevalence and clinical significance of esophageal motility disorders in patients with laryngopharyngeal reflux symptoms

Cited by 12 publications

References 38 publications

Distinct Clinical Physiologic Phenotypes of Patients with Laryngeal Symptoms Referred for Reflux Evaluation

Distinct Clinical Physiologic Phenotypes of Patients with Laryngeal Symptoms Referred for Reflux Evaluation

Clinical Characteristics of Patients With Ineffective Esophageal Motility by Chicago Classification Version 4.0 Compared to Chicago Classification Version 3.0

Clinical Update Findings about pH-Impedance Monitoring Features in Laryngopharyngeal Reflux Patients

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