Avaliação clinica, motora e laringoscopica de pacientes com doenca do refluxo gastroesofagico e exposicao acida patologica, com e sem sintomas laringofaringeos

Abstract

Patients with symptoms suggestive of Laryngopharyngeal Reflux Disease (LPR) have fewer typical symptoms than those with classical Gastroesophageal Reflux Disease (GERD). In addition, patients suspected of LPR have limited benefit with the use of proton pump inhibitors. This entity persists with controversies in clinical assessment, diagnosis, and treatment. This paper aims to analyze the similarities and differences between individuals with LPR who have confirmed GERD and individuals with classical GERD. We selected 44 individuals with altered 24-h intraluminal impedance and pH esophageal monitoring and divided into two groups, 19 with symptoms typical of GERD and 25 with laryngopharyngeal symptoms. All subjects underwent clinical evaluation, laryngoscopy and high resolution esophageal manometry (HRM). There was a significant difference in the typical symptoms questionnaire (RDQ) between the groups, the median of the GERD group was 14 and the DRLF was 29 (p = 0.010). In HRM, the contractile integral of the esophagogastric junction (CI-EGJ) was lower in the LPR group (p = 0.032) and the maximum pressure of the esophagogastric junction (Pmax) at rest was also lower in the LPR group (p = 0.012) . The values of the 24-h intraluminal impedance and pH esophageal were not significantly different between the groups. For the impedance, the acid proximal reflux number presented a negative correlation with resting CI-EGJ (p = 0.049, r = -0.309), with Pmax at rest (p = 0.034, r = - 0.331), with mean respiratory pressure of the esophagogastric junction (EGJ) at rest (p = 0.021, r = -0.359) and with CI-EGJ during respiratory sinus arrhythmia maneuver (p = 0.019, r = -0.364). Videolaryngoscopy, the Reflux Finding Score index was not different between the groups, but the finding of subglottic edema was more frequent in the LPR group (p = 0.012). Therefore, patients with LPR, when they have pathological acid exposure, present more typical symptoms than individuals with classic GERD, in addition, they have lower EGJ motor function. The lower the motor function of EGJ, the greater the number of proximal acid reflux. Laryngoscopy follows with controversial application for the diagnosis of LPR, but the finding of subglottic edema was more frequent in the LPR group. Keywords: Reflux, Laryngopharyngeal, Laryngoscopy, pH-metry, Larynx.