365 The Prevalence and Clinical Significance of Esophageal Motility Disorders in Patients Presenting With Laryngopharyngeal Reflux (LPR) Symptoms

Abstract

INTRODUCTION: Esophageal motor dysfunction may underlie impaired bolus and refluxate clearance in laryngopharyngeal reflux (LPR). However, the prevalence of co-existing esophageal dysmotility and correlation with reflux parameters and symptoms in LPR is unknown. METHODS: We conducted a retrospective study of consecutive patients with suspected LPR referred for high-resolution manometry (HRM) and combined hypopharyngeal-esophageal multichannel intraluminal impedance and pH testing (HEMII-pH) at a tertiary center in 3/2018-5/2019. Validated symptom surveys were prospectively collected at the time of testing, including Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Questionnaire (GERD-Q), and 12-item short-form health survey (SF-12). HRM findings were categorized using the Chicago Classification v3.0. Statistical analyses were performed using ANOVA or Fisher’s exact test. RESULTS: 113 patients (64% female, mean age 54.9 years) were included, with 52 (46%) having abnormal findings on HRM. The most common diagnosis was ineffective esophageal motility (IEM) [n = 37 (32.7%)]. 19 (16.8%) patients were found to have either a disorder of esophagogastric junction (EGJ) outflow or a major disorder of peristalsis, of which EGJ outflow obstruction (EGJOO) was the most prevalent diagnosis [n = 11 (9.7%)] (Table 1). With the exception of increased distal acid exposure time (AET) among patients with hypercontractile motility disorders (9% vs 2% in patients with normal HRM, P = 0.03), there were no differences in pharyngeal bolus reflux events, total bolus reflux events on impedance, and AET across HRM findings. Reporting throat symptoms as a primary complaint on presentation was associated with greater odds of having abnormal HRM compared to esophageal symptoms alone (OR 5.5, P = 0.005) (Figure 1). However, the presence and specific type of motility disorder were not associated with symptom severity as measured on RSI, GERD-Q, or health-related quality of life on the SF-12. CONCLUSION: Esophageal motility disorders are prevalent among patients with suspected LPR symptoms, including up to one of six with either a disorder of EGJ outflow or major disorder of peristalsis. Patients with these conditions are more likely to report throat symptoms as a primary complaint. However, there was no correlation between HRM findings and symptom severity. The role of esophageal motor dysfunction in patients with LPR symptoms remains to be further defined.