title: Nissen Fundoplication for Laryngopharyngeal Reflux After Patient Selection Using Dual pH, Full Column Impedance Testing: A Pilot Study.
abstract: OBJECTIVE
  Prior studies demonstrate inconsistent diagnostic strategies for laryngopharyngeal reflux disease (LPR) patients who are offered laparoscopic Nissen fundoplication (Nissen). Superior symptom resolution outcomes are demonstrated in patients with accompanying typical gastroesophageal reflux (GERD) symptoms. This study aims to evaluate the efficacy of selecting patients with LPR complaints for Nissen using full column, dual pH impedance catheters (multichannel intraluminal impedance catheters [MII]).
  
  
  METHODS
  All patients who underwent Nissen for management of LPR symptoms refractory to at least 3 months of twice daily (BID) proton pump inhibitor (PPI) therapy with reflux symptom index (RSI) of 13 or higher and who had demonstrable reflux on MII were included. Pre- and (minimum) 16 week post-Nissen RSI scores as well as LPR-specific complaints were collected.
  
  
  RESULTS
  Eleven patients met criteria. Nine subjects (5 female, 4 male) had complete data. All 9 (100%) achieved improvement in RSI. The average pre-Nissen RSI was 31.7, and average post-Nissen RSI was 10 (P < .001). Six (67%) subjects dropped below an RSI of 13. Seven subjects (78%) had resolution of their primary LPR symptom, and 6 (67%) subjects had resolution of all LPR symptoms.
  
  
  CONCLUSIONS
  Patients with LPR who are selected using dual pH and full column impedance are likely to demonstrate improvement in RSI following Nissen.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA tcarroll1@partners.org.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Carroll
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Kael
authors.initials: K
authors.lastname: Nahikian
authors.affiliation: University of California San Francisco, California, USA.
authors.forename: Ammar
authors.initials: A
authors.lastname: Asban
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wiener
mesh_terms: D000328:Adult; D000368:Aged; D017097:Electric Impedance; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010865:Pilot Projects; D012189:Retrospective Studies
keywords: LPR; Nissen fundoplication; atypical reflux; extraesophageal reflux; laryngopharyngeal reflux; multichannel intraluminal impedance; pH impedance