How effective is the control of laryngopharyngeal reflux symptoms by fundoplication? Symptom score analysis

Abstract

The diagnosis and management of laryngopharyngeal reflux (LPR) symptoms are made difficult by the lack of good standard tests for diagnosis and for assessment of responsiveness to medical therapy. Proximal esophageal 24‑h pH reading may help identify a group of patients likely to benefit from surgery. A consecutive cohort of patients from a prospective populated database were identified. Further review was undertaken by an independent investigator for symptomatic evaluation following fundoplication 24 months after surgery. There were 90 patients (70% female) treated by fundoplication. The 24‑h pH study was successful in 68 patients; abnormal test results were found in 62 patients. Two clinical groups of patients were identified (GORD predominant/LPR predominant) with better control of LPR symptoms in the mixed GOR/LPR cohort but improved overall (p < 0.01). Symptom control was incomplete. In selected patients with elevated proximal pH readings, symptom improvement of LPR can be achieved by fundoplication.