Divisions of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
J Voice. 2022 Nov;36(6):832-837. doi: 10.1016/j.jvoice.2020.09.003. Epub 2020 Sep 29.
Abnormal esophageal motility is prevalent in gastroesophageal reflux disease patients; however, its relationship with laryngopharyngeal reflux (LPR) symptom severity remains unclear. Altered esophageal transit may contribute to LPR symptoms. We aimed to examine the relationship between reflux symptom index (RSI), a validated questionnaire for LPR symptoms, and abnormal esophageal motility on high-resolution manometry (HRM).
A total of 133 consecutive patients (55.9 ± 14.6 years, 69.9% female) with suspected LPR referred for HRM and multichannel intraluminal impedance-pH study (MII-pH) at a tertiary center from March 2015 to October 2017 were included. RSI questionnaire was prospectively collected prior to motility testing. Authors analyzing HRM and MII-pH were blinded to RSI findings. Statistical analyses were performed using Student's t test or Pearson's correlation (univariate) and general linear regression (multivariable).
Mean RSI was higher among patients with ineffective esophageal motility than those with normal motility (23.7 vs 18.6, P = 0.01). Significant positive correlation was found between RSI and percent failed swallows (R = 0.21, P = 0.03), but not percent weak swallows. On multivariable analysis, percent ineffective (failed or weak) swallows was significantly associated with RSI (β-coefficient: 0.072, P = 0.05) after controlling for age, gender, BMI, smoking, prior PPI use, and reflux on MII-pH. When analyzed separately, percent failed swallows (β-coefficient: 0.095, P= 0.02), but not percent weak swallows, independently predicted higher RSI.
Ineffective swallows, particularly failed swallows, are independently associated with higher RSI in patients with suspected LPR, even after controlling for reflux on MII-pH. Esophageal dysmotility may play a role in suspected LPR symptoms independent of reflux. HRM should be routinely considered in evaluating these patients.
食管运动异常在胃食管反流病患者中很常见；然而，其与喉咽反流（LPR）症状严重程度的关系尚不清楚。食管转运异常可能导致 LPR 症状。我们旨在研究反流症状指数（RSI）与高分辨率测压（HRM）异常食管动力之间的关系，RSI 是一种用于 LPR 症状的经过验证的问卷。
2015 年 3 月至 2017 年 10 月，我们在一家三级中心对 133 例疑似 LPR 的连续患者（55.9±14.6 岁，69.9%为女性）进行了 HRM 和多通道腔内阻抗-pH 研究（MII-pH）。在进行动力测试前，前瞻性收集了 RSI 问卷。分析 HRM 和 MII-pH 的作者对 RSI 结果不知情。使用学生 t 检验或 Pearson 相关（单变量）和广义线性回归（多变量）进行统计分析。
无效食管动力患者的 RSI 高于正常动力患者（23.7 比 18.6，P=0.01）。RSI 与吞咽失败百分比呈显著正相关（R=0.21，P=0.03），但与吞咽无力百分比无关。多变量分析显示，在控制年龄、性别、BMI、吸烟、既往 PPI 使用和 MII-pH 反流后，无效（失败或无力）吞咽百分比与 RSI 显著相关（β系数：0.072，P=0.05）。单独分析时，吞咽失败百分比（β系数：0.095，P=0.02），而不是吞咽无力百分比，独立预测 RSI 较高。
无效吞咽，特别是吞咽失败，与疑似 LPR 患者的 RSI 较高独立相关，即使在控制 MII-pH 反流后也是如此。食管动力障碍可能在疑似 LPR 症状中独立于反流起作用。在评估这些患者时，应常规考虑 HRM。
