title: A study with pharyngeal and esophageal 24-hour pH-impedance monitoring in patients with laryngopharyngeal symptoms refractory to proton pump inhibitors.
abstract: BACKGROUND
  The role of gastroesophageal reflux in chronic laryngeal symptoms is difficult to establish. The aim of this study was to characterize pharyngeal and esophageal pH-impedance reflux patterns in a group of patients with suspected laryngopharyngeal reflux and to determine predictive factors of response to proton pump inhibitors.
  
  
  METHODS
  Patients with chronic pharyngolaryngeal symptoms were evaluated with a symptom score questionnaire, laryngoscopy, and 24-hour pharyngeal and esophageal pH-impedance monitoring at baseline and after 8-week treatment with esomeprazole 40 mg b.i.d. Response to treatment was defined by a diminution of more than 50% of the score for the primary symptom. Reflux patterns and baseline impedance values were compared to those obtained in 46 healthy subjects.
  
  
  RESULTS
  Twenty-four patients were included (17 women, median age 54 years), all previously refractory to antisecretory therapy. Symptom scores were 46 (32-62) and 40 (27-76) off and on therapy, respectively (P=.1). There was no significant difference between patients and controls for pH-impedance reflux parameters and baseline values off and on therapy in distal and proximal esophagus and in the pharynx. Median numbers of pharyngeal reflux were 0 and 0 off and on therapy, respectively. Only two patients were responders to treatment, both with excessive distal reflux but no pharyngeal reflux. Only one patient had abnormal pharyngeal reflux but did not respond to proton pump inhibitors.
  
  
  CONCLUSIONS
  Patients with suspected laryngopharyngeal reflux refractory to therapy do not exhibit abnormal pharyngeal or esophageal pH-impedance reflux. In these patients, laryngopharyngeal reflux is unlikely.
authors.affiliation: Gastroenterology Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Dulery
authors.affiliation: ENT Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Lechot
authors.affiliation: LabTAU, Inserm U1032, Univ Lyon, Lyon, France.|Digestive Physiology Department, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Roman
authors.affiliation: ENT Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France.
authors.forename: P-L
authors.initials: PL
authors.lastname: Bastier
authors.affiliation: ENT Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France.
authors.forename: D
authors.initials: D
authors.lastname: Stoll
authors.affiliation: ENT Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France.
authors.forename: L
authors.initials: L
authors.lastname: de Gabory
authors.affiliation: Gastroenterology Department, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Zerbib
mesh_terms: D000328:Adult; D000368:Aged; D004351:Drug Resistance / Q000187:drug effects / Q000502:physiology; D017097:Electric Impedance; D050782:Esophageal pH Monitoring / Q000379:methods*; D004947:Esophagus / Q000187:drug effects / Q000503:physiopathology*; D005260:Female; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods; D010614:Pharynx / Q000187:drug effects / Q000503:physiopathology*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors
keywords: ambulatory pH-impedance monitoring; gastroesophageal reflux; laryngopharyngeal reflux; proton pump inhibitors