The Prevalence and Clinical Significance of Esophageal Motility Disorders in Patients Presenting With Laryngopharyngeal Reflux (LPR) Symptoms

Abstract

Purpose: Esophageal motor dysfunction may underlie impaired bolus and refluxate clearance in laryngopharyngeal reflux (LPR). However, the prevalence of co-existing esophageal dysmotility and correlation with reflux parameters and symptoms in LPR is unknown. Methods: We conducted a retrospective study of 194 consecutive patients with suspected LPR referred for high-resolution manometry (HRM) and combined hypopharyngeal-esophageal multichannel intraluminal impedance and pH testing (HEMII-pH) at a tertiary center between 3/2018 and 8/2019. Validated symptom surveys were prospectively collected at the time of testing, including Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Questionnaire (GERD- Q), and 12-item short-form health survey (SF-12). HRM findings were categorized using the Chicago Classification v3.0. Results: Abnormal findings on HRM were identified in 43.8% of patients, of which the most common diagnosis was ineffective esophageal motility (33.0%). A disorder of esophagogastric junction (EGJ) outflow or a major disorder of peristalsis was identified in 13.4% of patients. Patients reporting esophageal symptoms upon presentation were more likely to have a primary motility disorder, and those symptoms tended to be more severe. Pharyngeal reflux exposure did not differ across HRM findings. Conclusion: Esophageal motility disorders are prevalent among patients with LPR symptoms, including up to one in eight with either a disorder of EGJ outflow or major disorder of peristalsis. Patients with these conditions are more likely to report esophageal symptoms on presentation. The role of esophageal motor dysfunction in patients with LPR symptoms remains to be further defined.