Post-reflux swallow-induced peristaltic wave is impaired in laryngopharyngeal and gastro-oesophageal reflux disease.

Abstract

Laryngopharyngeal reflux (LPR) and gastro-oesophageal reflux disease (GORD) result from the reflux of gastric contents. The post-reflux swallow-induced peristaltic wave (PSPW) is an oesophageal reflex that facilitates chemical clearance of gastric contents following reflux events. PSPW index is a novel parameter that has been validated in assessing the effectiveness of chemical clearance in GORD, but not in LPR. This study aimed to assess chemical clearance in LPR and GORD by measuring PSPW indices in a consecutive series of patients. Reviewers blindly analysed off-therapy impedance-pH tracings from 187 patients clinically categorized as LPR (n=105) or GORD (n=82) by predominant symptom profile. Conventional impedance-pH measures and PSPW indices were analysed. Mean PSPW index in the LPR group was higher than in the GORD group (39.7% (±17.7%) vs. 20.6% (±13.4%); p<0.001). Abnormally low PSPW index (<61%) was seen in 85 (81%) of the LPR group, and 80 (97.6%) of the GORD group (p<0.001). Area under the ROC curve for PSPW index to diagnose LPR was 0.83 (95% CI: 0.767-0.889; p<0.001). Post-reflux swallow-induced peristaltic wave was impaired in patients with LPR as well as oesophageal GORD, indicating an abnormality of chemical clearance following a reflux episode in both groups. PSPW index was more severely impaired in gastro-oesophageal reflux disease (GORD). The present study shows PSPW index is useful in the diagnosis of both LPR and GORD and exposes an abnormality of clearance of the oesophagus.