The Diagnosis of Laryngopharyngeal Reflux: The Role of Esophageal Mucosal Biopsy

Tae, Kyung; Lee, Yong Seop; Kim, Su Young; Jung, Jin Hyuk; Lee, Seung Hwan; Park, Yong Wook; Han, Dong Soo

Abstract

BACKGROUND AND OBJECTIVES: The reflux symptoms, laryngoscopic findings and 24-hour dual-probe pH monitoring are main diagnostic tools for laryngopharyngeal reflux disease. In particular, 24-hour dual-probe pH monitoring is the most specific and sensitive test, but some patients tend to fail the test due to discomfort. Eosinophilia in the esophageal mucosa may be diagnostic of gastroesophageal reflux disease, but esophageal biopsy has rarely been studied in laryngopharyngeal reflux. In this study, to discover another or alternative diagnostic tools that might help in the diagnosis of laryngopharyngeal reflux, we investigated the significance of esophageal mucosal biopsy in patients with laryngopharyngeal reflux symptoms.
SUBJECTS AND METHOD
The study group consisted of 110 patients with laryngopharyngeal reflux symptoms and all patients were evaluated by 24 hour dual probe pH monitoring. The results of the 24 hour dual probe pH monitoring was compared with reflux symptom index (RSI), reflux finding score (RFS), gastroesophagoscopic findings, esophagogram and esophageal mucosal biopsy.
RESULTS
In 61 of the 110 patients, laryngopharyngeal reflux were confirmed by 24 hour dual probe pH monitoring. The mean RSI and RFS of the laryngopharyngeal reflux group was higher (7.3+/-2.5, 6.0+/-3.9) than those of the group without laryngopharyngeal reflux (6.3+/-3.5, 4.6+/-2.9). Intraepithelial eosinophils in proximal esophageal biopsy was correlated with laryngopharyngeal reflux by 24-hour dual-probe pH monitoring.
CONCLUSION
Esophageal mucosal biopsy is a reliable diagnostic test for laryngopharyngeal reflux and it could be used for patients who tend to fail 24-hour dual-probe pH monitoring due to discomfort.