How many cases of laryngopharyngeal reflux suspected by laryngoscopy are gastroesophageal reflux disease-related?

Table 1 Results of the gastroesophageal reflux disease impact scale questionnaire before and after proton pump inhibitor therapy

How often have you had the following symptoms: (GIS questionnaire)	Before PPI therapy				After PPI therapy				P value
	Always	Often	Sometimes	Never	Always	Often	Sometimes	Never
Pain in your chest or behind the breastbone?	1	0	0	0	0	0	1	0	NS
Burning sensation in your chest or behind the breastbone?	10	4	1	0	3	1	1	10	< 0.05
Regurgitation or acid taste in your mouth?	2	5	2	0	1	1	3	4	< 0.05
Pain or burning in your upper stomach?	1	2	2	0	0	1	1	3	< 0.05
Sore throat or hoarseness that is related to your heartburn or acid reflux?	27	5	9	0	23	8	6	4	NS

NS: Not statistically significant; GIS: Gastroesophageal reflux disease impact scale; PPI: Proton pump inhibitor.

Table 2 Results of the visual analytic scale

Symptoms	Pre-PPI	Post-PPI	P value
Chest pain	7.1 ± 2.4	3.3 ± 0.9	0.00011
Heartburn	8.5 ± 3.2	2.3 ± 1.1	0.00011
Regurgitation	6.8 ± 1.5	4.1 ± 1.9	0.00011
Epigastric pain	5.9 ± 3.6	3.7 ± 2.4	0.0021
Hoarseness	7.4 ± 2.2	6.8 ± 2.7	0.273
Globus	9.3 ± 3.8	7.9 ± 3.5	0.087
Cough	7.9 ± 2.6	6.8 ± 2.8	0.069
Throat discomfort	8.1 ± 3.4	6.9 ± 2.1	0.058
Dysphonia	6.5 ± 2.1	5.5 ± 3.5	0.121

¹Statistically significant differences. PPI: Proton pump inhibitor.

Table 3 Laryngoscopic findings with the reflux finding score in 41 patients with suspected laryngopharyngeal reflux, classified using multichannel intraluminal impedance and pH monitoring

Laryngoscopic findings	Ordinal scale	ERD/NERD (5)	HE (11)	No GERD1 (25)	P value
Infraglottic oedema (pseudosulcus)	0 = Absent	4	10	23	0.592
	2 = Present	1	1	2
Ventricular obliteration	0 = None	4	8	21	0.553
	2 = Partial	1	3	4
	4 = Complete	0	0	0
Erythema/hyperemia	0 = None	0	0	1	0.474
	2 = Arytenoids only	2	6	15
	4 = Diffuse	3	5	9
Vocal fold oedema	0 = None	3	7	19	0.375
	1 = Mild	2	1	4
	2 = Moderate	0	3	2
	3 = Severe	0	0	0
	4 = Polypoid	0	0	0
Diffuse laryngeal oedema	0 = None	0	4	10	0.271
	1 = Mild	1	4	7
	2 = Moderate	2	3	5
	3 = Severe	2	0	3
	4 = Obstructing	0	0	0
Posterior commissure hypertrophy	0 = None	0	0	0	0.763
	1 = Mild	2	5	12
	2 = Moderate	1	5	10
	3 = Severe	2	1	3
	4 = Obstructing	0	0	0
Granuloma/granulation	0 = Absent	5	10	24	0.876
	2 = Present	0	1	1
Thick endolaryngeal mucus	0 = Absent	2	7	12	0.909
	2 = Present	3	4	10

¹Patients with normal acid exposure time and without correlation between symptoms and refluxes. ERD: Erosive esophagitis; NERD: Non erosive esophagitis; HE: Hypersensitive esophagus.

Table 4 Correlation between multichannel intraluminal impedance and pH analysis and the reflux finding score/ reflux symptom index analysis

	ERD/NERD	HE	No GERD1	P value
AET (%)	7.4 ± 3.2	3.5 ± 1.7	1.9 ± 0.8	< 0.05
Reflux number (n)	103.2 ± 12.1	44.7 ± 6.2	35.1 ± 7.4	< 0.05
Proximal refluxes (mean %)	31	29	18	< 0.05
Acid refluxes (n)	62.5 ± 15.4	32.9 ± 5.1	19.7 ± 6.2	< 0.05
Non-acid refluxes (n)	40.1 ± 7.6	13.1 ± 4.4	15.8 ± 4.9	< 0.05
Gas refluxes (n)	11.6 ± 9.7	13.1 ± 8.1	21.7 ± 15.3	< 0.05
SAP/SI	Positive	Positive	Negative	-
RFS	10.9 ± 3.3	9.1 ± 2.7	7.6 ± 3.1	NS
RSI	14.3 ± 5.2	16.3 ± 4.7	15.8 ± 4.9	NS

¹Patients with normal acid exposure time and without correlation between symptoms and refluxes. AET: Acid exposure time; ERD: Erosive esophagitis; NERD: Non erosive esophagitis; HE: Hypersensitive esophagus. SAP/SI: Symptom association probability/symptom index; RFS: Reflux finding score; RSI: Reflux symptom index; NS: Not statistically significant.

Table 5 Results of nominal and numerical correlation

	Nominal correlation			Numerical correlation
	RFS	RSI	RGE	RFS	RSI
AET (%)	NS	NS	P < 0.001	NS	NS
Total reflux number	NS	NS	P < 0.001	NS	NS
Acid reflux number	NS	NS	P < 0.05	NS	NS
Non-acid reflux number	NS	NS	P < 0.05	NS	NS
Proximal reflux number	NS	NS	P < 0.04	NS	NS
SAP	NS	NS	P < 0.009	NS	NS
Gas refluxes	P = 0.028	NS	NS	P = 0.026	NS
Upper endoscopy	NS	P < 0.001	P = 0.009	NS	NS
MII-pH (diagnosis)	NS	NS	P < 0.001	NS	NS

RFS: Reflux finding score; RSI: Reflux symptom index; RGE: Gastroesophageal reflux diagnosis; AET: Acid exposure time; NS: Not statistically significant; MII-pH: Multichannel intraluminal impedance and pH; SAP: Symptom association probability.