Prevalence of Gastro-esophageal Reflux Disease in Suspected Laryngo- pharingeal Reflux Unresponsive to Proton-pump Inhibitors

Background: Laryngopharyngeal Reflux (LPR) may be part of Gastroesophageal Reflux Disease (GERD). However, sometimes suspected LPR seems refractory to Proton Pump Inhibitors (PPI), questioning therefore the GERD diagnosis. Our aim was to evaluate the real-life prevalence of GERD in patients with a recent laryngoscopic diagnosis of LPR, and unresponsive to PPI. We also assessed whether other causes than GERD could explain the laryngoscopic findings in those patients. Methods: We retrospectively analyzed patients with the diagnosis of LPR, and unresponsive to PPI. Those patients must have been investigated by: upper gastrointestinal endoscopy with biopsies; multichannel intraluminal impedance and pH monitoring (MII-pH); X-ray of the chest and/or of the paranasal sinuses; hormonal thyroid assessment; prick tests to assess food and/or inhalants and pollen allergy. Results: We enrolled 28 patients (18, 64.3%, males and 10, 35.7%, females; median, IQR age 39.4, 21-75 yrs). Endoscopic hiatal hernia was found in 9/28 (32.1%) patients; the MII-pH analysis showed abnormality in 2/28 (7.14%) patients (both having also GERD symptoms); Chest X-ray found chest diseases in 2/28 (7.14%) patients and X-rays of the paranasal sinuses found sinusitis in 1/28 (3.6%); 2/28 (7.14%) patients had hyperthyroidism; food and/or inhalants and pollen allergy was found in 9 (32.1%) patients. In 12/28 (42.9%) patients, any of the investigated diseases was found. Conclusions: This study found that the real prevalence of GERD in patients with a recent laryngoscopic diagnosis of LPR, and unresponsive to PPI, is low. Moreover, more than 40% of them did not show any of the investigated diseases in real life.