Comparison of Patients of Chronic Laryngitis With and Without Troublesome Reflux Symptoms

An Jiang Wang; Mao Jin Liang; Ai Yun Jiang; Jin Kun Lin; Ying Lian Xiao; Sui Peng; Jie Chen; Wei Ping Wen; Min Hu Chen

Disclosures

J Gastroenterol Hepatol. 2012;27(3):579-585. 

In This Article

Abstract and Introduction

Abstract

Background and Aim: Little is known about the difference between patients of chronic laryngitis with and without troublesome reflux symptoms. The aim of this study was to compare the clinical characteristics and response to acid suppression between patients of chronic laryngitis with and without troublesome reflux symptoms.
Methods: Consecutive patients with chronic laryngitis were enrolled. The frequency and severity of reflux and laryngeal symptoms were scored. All the patients underwent laryngoscopy, esophagogastroduodenoscopy and 24-h multichannel intraluminal impedance and pH monitoring before receiving rabeprazole 10 mg b.i.d. for 3 months. Mild typical reflux symptoms (heartburn or regurgitation) occurring ≥ 2 days/week or moderate/severe symptoms occurring ≥ 1 day/week were defined as troublesome reflux symptoms.
Results: Compared to patients without troublesome reflux symptoms, those with troublesome reflux symptoms were older and had more episodes of acid and liquid gastroesophageal reflux (GER) and acid and weakly acidic laryngopharyngeal reflux (LPR). They also had higher percentages of both bolus exposure time and acid exposure time of GER and LPR. Patients with troublesome reflux symptoms responded to acid suppression more often at 12 weeks (67.3% vs 20.9%, P < 0.001) and more rapidly (40.8% vs 14.0%, 3 weeks after the start of acid suppression; P = 0.004) compared to those without.
Conclusion: Difference in reflux profile of GER and LPR between patients with and without troublesome reflux symptoms could partly explain the discrepancy of response to acid suppression among patients with chronic laryngitis. Acid suppression therapy may provide limited therapeutic benefits to patients of chronic laryngitis without troublesome reflux symptoms.

Introduction

Gastroesophageal reflux disease (GERD) has been widely recognized as a cause of chronic laryngitis, which is often referred as reflux laryngitis syndrome (RLS).[1] It seems that most patients with RLS require more aggressive and prolonged proton pump inhibitor (PPI) treatment to achieve improvement of laryngeal symptoms than those with GERD.[2] However, most placebo-controlled trials and meta-analyses have failed to demonstrate any therapeutic benefit of PPI.[3–9]

Some studies have revealed that the proportion of patients with marked improvement in laryngeal symptoms is significantly higher in patients with GERD compared to those without GERD.[10,11] It appears that patients with and without GERD have distinct underlying pathophysiologies and require different management approaches. However, these studies gave no information about the reflux profile related to the underlying pathophysiology. In addition, a large proportion of patients with troublesome typical reflux symptoms and chronic laryngitis did not have any objective finding of GERD, such as erosive esophagitis or pathological esophageal acid exposure. The underlying pathophysiological mechanism and the efficacy of acid suppression on these patients are still unknown. It would be simpler and more practical for physicians to evaluate whether patients with chronic laryngitis could benefit from acid suppression therapy depending on symptoms rather than the diagnosis of GERD defined by objective exams in our daily clinical practice. Unfortunately, systematic investigations of the difference between patients with chronic laryngitis with and without troublesome reflux symptoms have not been reported yet. So, we have set out to study a carefully selected group of patients with chronic laryngitis, to compare the clinical characteristics, including reflux profile and response rate to acid suppression, between them.

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