Ineffective Esophageal Motility Is Independently Associated with Higher Reflux Symptom Index (RSI) Score in Subjects with Suspected Laryngopharyngeal Reflux

Abstract

Introduction: Evaluation and management of suspected laryngopharyngeal reflux (LPR) symptoms is challenging, and the effectiveness of anti-reflux therapy has been varied. Esophageal dysmotility may also play a role in LPR symptoms. The association between esophageal dysmotility on high-resolution manometry (HRM) and objective measures of LPR symptoms such as the reflux symptom index (RSI) is not known. A better understanding of the HRM patterns found in patients with suspected LPR may further our understanding of this clinical presentation, particularly when reflux assessment alone fails to establish a diagnosis. We aimed to examine the association between abnormal HRM findings in patients with suspected LPR and RSI. Methods: This was a retrospective study of all patients with suspected LPR who underwent HRM and multichannel intraluminal impedance and pH study (MII-pH) at a tertiary center in 3/2015-5/2016. All patients completed the reflux symptom index (RSI) questionnaire within 3 months of testing. Chart review was performed to collect data on demographics, medical history, clinical symptoms, and prior PPI use. Abnormal HRM findings were categorized using Chicago Classification v3.0. The associations between RSI score and HRM findings were evaluated using student's t-test for univariate analysis and general linear regression for multivariate analysis. Results: 47 patients (mean age = 55.6±13.7, 74.5% female) met criteria for inclusion. On univariate analysis, the mean total RSI score was significantly higher among patients with ineffective esophageal motility (IEM), defined as failed or weak swallows ≥50%, compared to those with normal motility (27.8 vs 19.8, p=0.03). No association between other HRM findings and RSI scores was found. On multivariate analysis, after controlling for age, gender, PPI use, and bolus exposure (measured on MII-pH), IEM remained independently associated with a higher total RSI score (β coefficient: 8.36, p=0.04). No association was found between parameters on MII-pH testing alone and RSI score. Conclusion: IEM is independently associated with a higher total RSI score among patients with LPR symptoms, even after controlling for abnormal reflux on MII-pH. Esophageal dysmotility may contribute to LPR symptoms and should be routinely considered in the work-up of suspected LPR.