The role of nonacid reflux in laryngopharyngeal reflux diseases
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LARYNGOLOGY
The role of nonacid reflux in laryngopharyngeal reflux diseases Jinrang Li1 · Jiasen Wang1 · Mukun Wu1 · Jing Zhao1 · Hongguang Guo1 Received: 21 March 2020 / Accepted: 25 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To analyze the role of nonacid reflux in laryngopharyngeal reflux diseases (LPRD). Methods From January 2014 to April 2019, 344 patients associated with LPRD underwent 24-h multichannel intraluminal impedance–pH monitoring, and their reflux symptom index (RSI) and reflux finding score (RFS) were recorded. The numbers of acid, weakly acidic and alkaline reflux events in the laryngopharynx were counted, and the consistency analysis of the results with the results of the RSI and RFS was conducted. Results Among the 344 patients, nonacid reflux events accounted for 74.1% (1367/1845) of the all reflux events. There were 111 patients with ≥ 3 acid reflux events, 218 patients with ≥ 3 any kinds of reflux events, and 257 patients with positive results of RSI or RFS. Taking the results of the RSI and or RFS as a reference, the sensitivity, specificity and consistency test Kappa value for the diagnosis of LPRD according to the existence of ≥ 3 acid reflux events were 41.2%, 94.2% and 0.228, respectively. With the existence of three or more all kinds of reflux events as the standard, the sensitivity, specificity and consistency test Kappa value were 76.7%, 74.7% and 0.449, respectively. Conclusion The nonacid reflux events account for the highest proportion of laryngopharyngeal reflux events, and the consistency of the results of RSI and or RFS with all reflux events is higher than that with only acid reflux events, that indicates nonacid reflux may play an important role in LPRD. Keywords Nonacid reflux · Laryngopharyngeal reflux · Esophageal pH monitoring · Symptoms and signs
Introduction Laryngopharyngeal reflux diseases usually refer to the reflux of gastric contents above the upper esophageal sphincter causing a series of symptoms and signs. It is generally believed that the gastric acid and pepsin in the gastric contents can directly injury the mucosa of the pharynx, larynx, trachea and other parts of the upper aerodigestive tract. In recent years, it has been found that except for gastric acid and pepsin, bile salt and other duodenal proteins not only affect the pharynx and larynx mucosa, but also extend to all upper aerodigestive tract mucosa [1–4]. However, duodenal contents such as bile salt are the main components of nonacid reflux, and the effect of nonacid reflux on pharyngeal and laryngeal symptoms is still uncertain. This paper aims * Jinrang Li [email protected] 1
Department of Otorhinolaryngology Head and Neck Surgery, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China
to explore the relationship between nonacid reflux and laryngopharyngeal reflux symptoms and signs and study the role of nonacid reflux in laryngopharyngeal reflux diseases.
Materials and methods Before the study, the Institutional Review B
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