Abstracts
2002 Digestive Disease Week

# 107360 Abstract ID: 107360 Fundoplication in Patients with Laryngopharyngeal Reflux and Normal Distal Esophageal Acid Exposure Times
Jeffrey D Pearce, Benjamin M Hopkins, Gegory N Postma, Peter Belafsky, Kevin Bach, James Koufman, Carl J Westcott, Winston-Salem, NC

Introduction: Laryngopharyngeal reflux (LPR) is different from typical gastroesophageal reflux disease. Patients with LPR commonly note symptoms of cough, pharyngitis, hoarseness, and/or globus. Repeat laryngeal exposure to gastric contents can lead to subglottic stenosis, laryngospasm, and other sequela. The diagnosis of LPR typically involves a work up including history, laryngoscopy, and 24-hour esophageal pH monitoring. However, a number of patients with LPR have 24-hour pH probe results that do not meet the DeMeester criterion for significant reflux disease. We reviewed our institution's experience to determine the efficacy of gastric fundoplication in patients with LPR and normal 24-hour distal esophageal pH probe findings. Methods: Patients who underwent fundoplication for LPR were identified through an interdepartmental patient database. Those patients with preoperative 24-hour esophageal pH probes deemed normal by DeMeester criterion were included in our cohort. A retrospective chart review was then performed on all patients in the cohort. Patients' response to pre and postoperatively administered reflux symptom index (RSI) and disease specific quality-of-life index (QLI) and a standardized laryngoscopic grading scale for reflux (RFS) were recorded. A paired t-test was utilized to compare pre and postoperative responses. Results: From 1996 to 2000 52 fundoplications were performed for LPR. 30 of the patients with LPR had one or more lower esophageal 24-hour pH probes which did not meet DeMeester composite criteria (mean=9.59) for significant reflux disease; this group made up our cohort. The group consisted of 24% males, 76% females and had a median age of 48 years. With complete data from 14 (47%) patients in the cohort, the mean RSI improvement was 9.8 (p<0.01) and the mean QLI improvement was 6.9 (p<0.01). Laryngeal physical findings improved from 12.3 (+/- 2.8) pre-op to 4.8(+/-1.5) post-op (p=0.027). Conclusions: LPR and typical esophageal reflux are overlapping pathophysiologic entities. Those at the extreme end of the LPR spectrum may have significant disease which is missed with the conventional esophageal type reflux work up. Pharyngeal pH monitoring and serial laryngoscopy are useful in this population. Normal distal esophageal acid contact times may not be a contraindication to fundoplication in selected patients.