Different clinical symptom patterns in patients with reflux micro-aspiration confirmed by new pulmonary aspiration scintigraphy technique

Abstract

<b>Background:</b> Little primary reported data exists on presenting symptoms of patients with confirmed reflux micro-aspiration. The aim of this study is to report symptoms and presenting patterns of a large group of patients with reflux micro-aspiration. <b>Patients and methods:</b> Data was extracted from a prospectively populated database of patients with severe refractory, or atypical reflux. Patients with proven reflux micro-aspiration on new technique scintigraphy were included. A comparator group of patients with proven proximal reflux to the level of pharynx was also included. <b>Results:</b> Inclusion criteria were met by 243 patients with confirmed reflux micro-aspiration (33% males; mean age 59, range 17-88). Most common symptoms amongst patients with micro-aspiration were regurgitation (72%), cough (67%), heartburn (66%), throat clearing (65%), and dysphonia (53%). The most common two-symptom combinations were heartburn/regurgitation, cough/throat clearing, regurgitation/throat clearing, cough/regurgitation and dysphonia/throat clearing. The most common three-symptom combinations were cough/heartburn/regurgitation, cough/regurgitation/throat clearing and dysphonia/regurgitation/throat clearing. Cluster analysis demonstrated two main symptom groupings, one suggestive of proximal volume reflux symptoms and the other with inflammatory bowel syndrome (IBS)-like symptoms. <b>Conclusion:</b> Combination of typical symptoms of GORD such as heartburn or regurgitation and a respiratory or upper aero-digestive complaint such as cough, throat clearing, voice change should promt consideration of reflux micro-aspiration. Atypical symptoms may result from IBS-type abnormality.