Autonomic dysfunction in laryngopharyngeal reflux: heart rate variability and its association with esophageal motility.

BACKGROUND/AIMS: Laryngopharyngeal reflux disease (LPRD) has been associated with dysfunction of the autonomic nervous system (ANS), which may contribute to esophageal motility disorders and reflux events. However, the interactions between ANS function, esophageal motility, and psychological factors in LPRD remain poorly understood. This study aims to investigate ANS dysfunction in LPRD and its relationship with esophageal motility and reflux symptoms.

METHODS

Heart rate variability (HRV) analysis was conducted to assess ANS function in LPRD patients and healthy controls at rest. The impact of acid-base reflux on ANS activity was evaluated using pH-specific beverage challenge tests. Esophageal motility parameters were analyzed in relation to ANS function.

RESULTS

LPRD patients exhibited reduced vagal and sympathetic activity at rest compared to controls. Although LPRD patients with elevated upper esophageal sphincter pressure (UESP) showed a trend toward higher overall autonomic activity, and those with decreased lower esophageal sphincter pressure (LESP) exhibited concurrent increases in both sympathetic and vagal activity, these differences were not statistically significant. Impaired peristalsis indicated diminished vagal function. LPRD patients reported higher levels of depression (45.09 ± 11.00 vs. 37.38 ± 12.85, P = 0.001) and anxiety (42.83 ± 9.19 vs. 36.5 ± 9.44, P = 0.001), with anxiety correlating with reflux severity.

CONCLUSIONS

LPRD is associated with autonomic dysfunction, reduced vagal activity, esophageal motility disturbances, and reflux events. Psychological factors, particularly anxiety and depression, may exacerbate the condition. Monitoring ANS function and incorporating targeted interventions could improve treatment outcomes and quality of life for LPRD patients.