Fundoplication for laryngopharyngeal reflux disease.
BACKGROUND
Laryngopharyngeal reflux (LPR) disease arises from the effects of refluxed gastric contents on the proximal aerodigestive tract. LPR patients are often lumped into the category of "atypical" reflux. LPR symptoms are hoarseness, globus, cough, and pharyngitis. Severe disease is associated with subglottic stenosis and laryngeal cancer. Treatment includes lifestyle modifications and medications. The role of fundoplication for LPR has yet to be defined.


METHODS
Forty-one patients underwent fundoplication for LPR. They were prospectively followed with three outcomes measures: The Reflux Symptom Index, a laryngoscopic grading scale (Reflux Finding Score), and a reflux-based specific quality-of-life scale.


RESULTS
Average early followup was at 4 months and late followup was at 14 months. The Reflux Symptom Index improved by 5.4 early (p < 0.05) and 6.5 late (p < 0.05). Improvement between early and late periods approached significance (p < 0.09). Reflux Finding Score improved 3.8 (p < 0.05) early and 4.4 (p < 0.05) late. The Quality of Life Index improved 0.6 early and 2.3 (p < 0.05) late. By Reflux Symptom Index criteria, 26 patients were improved early versus 35 late (p < 0.05). Factors associated with poor outcomes were structural laryngeal changes in five patients (p < 0.05) and no response to proton pump inhibitors in six patients (p < 0.05).


CONCLUSIONS
Fundoplication augments treatment of LPR. Improvement of symptoms continues past the first 4 months. Laryngoscopy is critical in patient selection because selected findings are associated with outcomes, diagnosis, and management.
Westcott
Carl J
CJ
Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Hopkins
M Benjamin
MB
Bach
Kevin
K
Postma
Gregory N
GN
Belafsky
Peter C
PC
Koufman
James A
JA
D000328:Adult; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery* / Q000628:therapy; D006801:Humans; D007818:Laryngeal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D007828:Laryngoscopy; D008171:Lung Diseases / Q000209:etiology / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D011446:Prospective Studies; D016896:Treatment Outcome