Mo1115 Salivary Pepsin Concentrations Are Higher for Patients With Reflux Associated Laryngeal Symptoms: A Prospective Pilot Study

Abstract

Background: It has been demonstrated, using 24h pH-impedance monitoring (MII-pH), that NERD patients not responding to PPIs are characterized, respect to responders, by an increased overall number of refluxes and by enhanced sensitivity to mixed and proximal reflux episodes. It has been also shown that non-responders swallow more air at mealtime than responder patients. Aim: To explore the relationship between swallowing and reflux pattern in 24 hours in NERD patients responding or not to PPIs. Methods: MII-pH was performed, after a washout from PPIs, in 41 NERD non-responders and in 70 responders to double dose of PPIs, presenting with typical symptoms, following esophageal manometry. All patients filled out a questionnaire with symptom score. Acid exposure time (AET) and Symptom Association Probability (SAP) index were calculated. For each patients, swallows were evaluated during the entire length of MII-pH study, excluding meal period. Air swallowing was also assessed. Due to the high frequency of artifacts, the meal period was excluded from the analysis. Patients were instructed to have 3 meals and 4 beverages at fixed times. Results: 11 non responders (4 with ineffective esophageal motility, 7 with normal AET and SAP) and 20 responders (9 with ineffective esophageal motility, 11 with normal AET and SAP) were excluded thus 30 non-responders and 50 responders were studied. Nine nonresponders and 29 responders showed a pathological AET. Non responder patients were characterized, compared to responders, by a higher overall number of reflux episodes (median, 25th-75th percentile; 67, 43-94 vs 42, 31-65, p<0.01). The proportion of weakly (41% vs 39%), mixed (46% vs 44%) and proximal (53% vs 47%) reflux episodes did not differ between non responders and responders. During MII-pH, non responders swallowed more frequently than responders (mean±SD, 445±112 vs 381±89, p<0.05). The swallow rate per hour was 19±4.9/h in non responders and 16.6±3.9/h in responders. In both non responders and responders the swallowing frequency significantly decreased during sleep (13.3±1.2/h and 11.4±0.8/h, p<0.01). Swallows were followed by reflux episodes after 56.5±18.4sec. in non responders and 75±22.8 in responders (p<0.01). The frequency of air swallows were comparable between the two groups (56% vs 49%). Conclusions: Non responder NERD patients are characterized by an increased frequency of swallows during 24 hours. This finding may explain the increased number of reflux episodes observed in non responder patients, and further support the role of mucosal sensitization in this subgroup of patients.