Unprecedented Prevalence of Laryngopharyngeal Reflux (LPR) Amongst Gastro-Oesophageal Reflux (GORD) Sufferers. Is Underdiagnosis Leading to Mismanagement of GORD Patients?

Introduction: Laryngopharyngeal Reflux (LPR) exists if there are >3 episodes of pharyngeal pH <5 in a 24 hr period. The larynx is exquisitely sensitive to peptic injury and LPR has been implicated in the aetiology of many conditions including laryngeal carcinoma. LPR has been considered an otolaryngological (ENT) condition as fewer than 10% of patients manifest oesophagitis or Barretts oesophagus. We undertook to assess the prevalence of LPR in a cross-section of ENT and gastro-oesophageal reflux (GORD) patients.

Methods: Forty-six consecutive patients with symptoms or signs of acid-related reflux disease referred for pH studies underwent dual-channel testing to evaluate oesophageal and pharyngeal acidity. Results were correlated with endoscopic findings. Wilcoxon was used for statistical analysis.

Results: There were 13 ENT patients and 33 GORD referrals. 43% of all patients were found to have laboratory evidence of LPR. Pharyngeal pH <5 (upright position) p=0.003. Pharyngeal pH<5 (supine) p=0.001. Total pharyngeal pH <5, p=0.0006. Thirty-three patients had a positive DeMeester score, 19 of whom had LPR. Of these 26% had Barretts oesophagus. Only 3 of 13 ENT referrals had LPR whereas 57% of GORD patients demonstrated LPR.

Conclusion: LPR is far more prevalent than currently realised, and there may be a significant association with Barretts oesophagus. As standard therapy for GORD is insufficient to adequately treat LP, the majority of GORD patients continue to suffer LPR. Dual channel pH testing may be indicated in all GORD patients to identify this substantial sub-population and optimise their management.