Acid Reflux to the Proximal Esophagus Predicts Postoperative Success in Patients with Laryngopharyngeal Reflux Disease
Carlos Godinez*1, Stephen M. Kavic1, George T. Fantry3, Paul F. Castellanos2, J. Scott Roth1, F Jacob Seagull1, Adrian E. Park1
1Surgery, University of Maryland Medical Center, Baltimore, MD; 2Otolaryngology, UAB, Birmingham, AL; 3Gastroenterology, University of Maryland Medical Center, Baltimore, MD
Background: Acid reflux to the proximal esophagus and oropharynx is reasonably assumed to play a role in the etiology of atypical symptoms of reflux disease. To date, little published data exists to confirm this relationship. Similarly, the role of laparoscopic Nissen fundoplication (LNF) as therapy for this condition remains unproven over the long term. We theorized that symptoms of laryngopharyngeal reflux disease (LPR) could be correlated to documented episodes of proximal acid reflux, and that LNF would improve or relieve these symptoms.
Methods: One hundred and forty-three patients were diagnosed with LPR based upon clinical evaluation, 24 hour esophageal pH probe monitor, and Reflux Symptom Index (RSI) score. pH probe data was analyzed for total number of proximal reflux episodes (defined as pH < 4.0 in the proximal esophagus), and correlation of symptom occurrence with proximal reflux episodes. Patients who underwent operation then completed validated symptom assessment instruments at multiple time points postoperatively.
Results: Since July 2002, 114 patients have undergone LNF for laryngopharyngeal reflux at our institution. Patients were followed for up to 3 years (mean follow-up 11.5 months). pH probe data was available for analysis on 45 patients. Eighteen patients (40%) reported symptoms in association with proximal reflux. Following LNF, Reflux Symptom Index score improved most significantly in patients experiencing five or more symptomatic proximal reflux episodes, compared to those experiencing four or fewer (p=0.045). Further, patients whose absolute number of proximal reflux episodes exceeded thirty in a 24 hour period, regardless of symptom correlation, also had greater improvement in postoperative RSI scores (p=0.032).
Conclusions: Full-height acid reflux episodes do not uniformly correspond to symptom occurrence in patients with LPR. However, patients experiencing five or more symptomatic proximal reflux episodes in a 24 hour period report greater improvement in atypical symptoms following LNF. LNF is an effective therapy for LPR in carefully selected patients.
