The role of esophageal function testing in patients with laryngopharyngeal symptoms

Patients with laryngopharyngeas symptoms (LS) are frequently referred to gastroenterologists to investigate extraoesophageal manifestation of GastroOesophageal Reflux Disease. The aim of our present study was to review the patients with persistent LS referred to our laboratory for complex esophageal evaluation with respect to GORD. Patients and methods: Forty-six patients (14 males) with LS who have previously undergone laryngological examination and received empiric proton pump inhibitor (PPI) therapy were evaluated retrospectively. The patients were referred for oesophageal function testing for unsatisfactory PPI therapy. None of them was current smokers. The presence of LS and GORD symptoms were evaluated in the history. Upper gastrointestinal endoscopy, esophageal manometry and combined multichannel intraluminal impedance and pH- metry (MII-pH-metry) were performed in all of them. All patients were studied off-PPI. Results: Thirty-one patients (67.4%) also had typical reflux symptoms. The most frequent LS were globus sensation (20/46; 43.5%), hoarseness (13/46; 28.3%), throat pain (9/46; 19.6%), choronic cough (5/46; 10.1%). All but 5 patients reported more than one LS. In 5 (10.1%) patients hoarseness was the only LS. Eight out of 46 patients (17.4%) proved negative in each test, and in 5 of them hoarseness was the only symptom. At endoscopy erosive reflux disease was diagnosed in 3 out of 46 patients and 15 of them (32.6%) had hiatal hernia. Three out of 46 (6.5%) patients presented with esophageal dismotility at manometry. Above normal DeMeester score was found in half of the patients and the percentage of proximal reflux was abnormal in 19/46 patients. There was no significant difference in the LS pattern and in the proximal reflux in the subgroups patients with and without hiatal hernia. All tests were negative in the 5 patients with hoarseness alone. Subgroup analysis did not reveal any further symptom association. Conclusion: Patients with laryngo-pharyngeal symptoms resistant to PPI treatment remain difficult to manage, but detailed oesophageal function testing might reveal different mechanisms or reflux unrelated development of a symptom such as hoarseness in a significant number of our patients.