Effectiveness of Esophagography as a Screening Test of LPR

Chung, Phil Sang; Lee, Sang Joon; Chung, Yong Won; Kim, Myung Chan; Ryun, Jun Sik; Rhu, Dong Suh

Abstract

BACKGROUND AND OBJECTIVES
Laryngopharyngeal reflux (LPR), a most common cause of non-infectious laryngitis, occupies 20~30% of ENT outpatients, and over a half of patients who complains of voice disorder and laryngeal symptoms are associated with LPR. So we evaluate the usefulness of the esophagography as an initial screening test for patients suspected of LPR. SUBJECTIVES AND METHOD: From 2000 to 2002, we performed esophagography with water-siphon (WS) test for 540 patients with typical symptoms and telescopic findings. The results of esophagography were compared with those of 113 patients confirmed with gastroesohageal reflux (GER) and 174 patients without LPR or GER. The results of WS test were classified into normal, mild, moderate and severe according to the degree of reflux. RESULTS: In the WS test of LPR group, 48 patients were normal (8.9%), 166 mild (30.7%), 143 moderate (26.5%) and 183 severe degree of reflux (33.9%). We evaluated moderate and severe degree of reflux as having positive findings of the WS test because mild degree of reflux can be seen in physiologic conditions. In the LPR group, the positive ratio of WS test was 60.4%. In GER group, 12 patients were normal (10.6%), 30 mild (26.5%), 31 moderate (27.7%), 40 severe degree of reflux (35.4%) and 62.8% of positive WS test. In 174 patients without LPR or GER, 73 patients were normal (42.0%), 40 mild (23.0%), 17 moderate (9.8%) and 44 presented severe degree of reflux (25.2%). Fourty-two patients of the 540 LPR group (7.8%) showed esophageal lesions in esophagography. CONCLUSION: In literature, the sensitivity of esophagography is reported as 33%, but reflux provocation using the WS test increases the sensitivity over 60%. Also, esophagography can demonstrate esophageal abnormalities that might otherwise be missed. So we confirmed the effectiveness of esophagography as a strong initial screening test for LPR.